How Do You Treat A Strep Carrier

[swim]

Our oldest son has been dealing with PANDAS symptoms for about 6 years. After our youngest son started showing signs of PANDAS for the first time about 2 weeks ago, our ped suggested my husband and I get tested to see if we were strep carriers.

 

The results are in and I tested positive as a strep carrier. My doctor is willing to treat, but has never treated a strep carrier before. I have seen threds about carriers needing the right antibiotics for the right length of time, but I am not sure what the "right" antibiotic is or how long treatment should start with. Does anyone have any advice or experiences to share so I can get started with a treatment?

[Joan Pandas Mom]

How do you test for a carrier? I am wondering if I am a carrier. I have asked a few Dr.'s if family members should be tested and they told me not to bother getting tested.

 

Our oldest son has been dealing with PANDAS symptoms for about 6 years. After our youngest son started showing signs of PANDAS for the first time about 2 weeks ago, our ped suggested my husband and I get tested to see if we were strep carriers.

 

The results are in and I tested positive as a strep carrier. My doctor is willing to treat, but has never treated a strep carrier before. I have seen threds about carriers needing the right antibiotics for the right length of time, but I am not sure what the "right" antibiotic is or how long treatment should start with. Does anyone have any advice or experiences to share so I can get started with a treatment?

[swim]

Our doctor did a throat culture, a nose culture and blood tests. Throat, nose and ASO turned out negative, but DNAseB turned out positive. My husband turned out negative on all tests.

[Joan Pandas Mom]

Thanks. I am going to have those done. Please let us know the treatment for carriers and good luck.

[thereishope]

Clindamycin is a popular antibiotic for a carrier. I believe EAMom's daughter did well with Azith.

[KeithandElizabeth]

Interesting.... My husband, who has never been sick or on antibiotics during our 20 years together, had a negative ASO and positive ANTI DNASE B. I put him on 500mg. of AZITH because I didn't know what else to do and I was so worried about our PANDAS children. His doctor referred him to an Infectious Disease doctor because of our situation. I will let you know how our appointment goes in two weeks. I fear that I will know more than this doctor and we will walk away disappointed.

 

Elizabeth

[swim]

Elizabeth - Thank you for your reply. Like your husband, I am rarely ever sick and the last time I was on antibiotics was over 22 years ago. I will let you know what we decide to do with me and how it goes. Please let me know if you get lucky and find a good Infectious Disease doc. It will be interesting to see how this plays out.

[laurenjohnsonsmom]

Do you care to share which doc's told you not to bother testing the family? These weren't PANDAS doc's were they?

 

How do you test for a carrier? I am wondering if I am a carrier. I have asked a few Dr.'s if family members should be tested and they told me not to bother getting tested.

 

Our oldest son has been dealing with PANDAS symptoms for about 6 years. After our youngest son started showing signs of PANDAS for the first time about 2 weeks ago, our ped suggested my husband and I get tested to see if we were strep carriers.

 

The results are in and I tested positive as a strep carrier. My doctor is willing to treat, but has never treated a strep carrier before. I have seen threds about carriers needing the right antibiotics for the right length of time, but I am not sure what the "right" antibiotic is or how long treatment should start with. Does anyone have any advice or experiences to share so I can get started with a treatment?

[Buster]

A couple of things:

1. Carriage is usually shorthand for "asymptomatic carriage" and is defined as having a positive throat culture for > 14 days and not having an immunologic response
    
   
2. A rising titer (of ASO or AntiDNAse B ) is an indication of a prior GABHS infection, but to find the rising titer you must do two draws 1-2 weeks apart (i.e., have a baseline againt which to measure).
    
   
3. Most doctors don't have the two titers and use the "Upper Limit of Normal" ULN as a baseline measurement. Statistically, this works out to be a good indicator for kids with strong immunologic responses on first draw -- however, with only a single draw, you do not know if the titer is rising or falling.
    
   
4. The titer can rise even if there is no present GABHS infection. ASO rises in 46% of people 1-4 weeks post initial-infection. AntiDNAseB rises 6-8 weeks post initial-infection. In 31% of people neither ASO nor AntiDNAseB rise despite a positive throat culture.
    
   
5. A constant titer is meaningless. If significantly elevated it is possible that there is a recurrent infection but there is no reliable study indicating how to interpret a constant titer. To be safe, most doctors treat an elevated titer as if it were rising and in the absence of positive throat swab will inquire about a possible sinus, vaginal or skin infection.
    
   
6. A falling titer is also not really helpful. The rate of fall of titers is not studied. In many, AntiDNAseB can stay elevated for months.
   

In general, trust the throat culture first.

 

Bottom line, I have no idea how the doctor would have called you a carrier as you only had a single measurement and no postiive culture.

 

Regards,

 

Buster

 

 

Elizabeth - Thank you for your reply. Like your husband, I am rarely ever sick and the last time I was on antibiotics was over 22 years ago. I will let you know what we decide to do with me and how it goes. Please let me know if you get lucky and find a good Infectious Disease doc. It will be interesting to see how this plays out.

[Joan Pandas Mom]

No neither were PANDAS Docs. I decided to go to one of the Dr.'s mentioned here. I have a phone consult Thursday.

 

Do you care to share which doc's told you not to bother testing the family? These weren't PANDAS doc's were they?

 

How do you test for a carrier? I am wondering if I am a carrier. I have asked a few Dr.'s if family members should be tested and they told me not to bother getting tested.

 

Our oldest son has been dealing with PANDAS symptoms for about 6 years. After our youngest son started showing signs of PANDAS for the first time about 2 weeks ago, our ped suggested my husband and I get tested to see if we were strep carriers.

 

The results are in and I tested positive as a strep carrier. My doctor is willing to treat, but has never treated a strep carrier before. I have seen threds about carriers needing the right antibiotics for the right length of time, but I am not sure what the "right" antibiotic is or how long treatment should start with. Does anyone have any advice or experiences to share so I can get started with a treatment?

[sf_mom]

Buster,

 

Thanks for posting.... extremely helpful.

 

-Wendy

 

A couple of things:

1. Carriage is usually shorthand for "asymptomatic carriage" and is defined as having a positive throat culture for > 14 days and not having an immunologic response
    
   
2. A rising titer (of ASO or AntiDNAse B ) is an indication of a prior GABHS infection, but to find the rising titer you must do two draws 1-2 weeks apart (i.e., have a baseline againt which to measure).
    
   
3. Most doctors don't have the two titers and use the "Upper Limit of Normal" ULN as a baseline measurement. Statistically, this works out to be a good indicator for kids with strong immunologic responses on first draw -- however, with only a single draw, you do not know if the titer is rising or falling.
    
   
4. The titer can rise even if there is no present GABHS infection. ASO rises in 46% of people 1-4 weeks post initial-infection. AntiDNAseB rises 6-8 weeks post initial-infection. In 31% of people neither ASO nor AntiDNAseB rise despite a positive throat culture.
    
   
5. A constant titer is meaningless. If significantly elevated it is possible that there is a recurrent infection but there is no reliable study indicating how to interpret a constant titer. To be safe, most doctors treat an elevated titer as if it were rising and in the absence of positive throat swab will inquire about a possible sinus, vaginal or skin infection.
    
   
6. A falling titer is also not really helpful. The rate of fall of titers is not studied. In many, AntiDNAseB can stay elevated for months.
   

In general, trust the throat culture first.

 

Bottom line, I have no idea how the doctor would have called you a carrier as you only had a single measurement and no postiive culture.

 

Regards,

 

Buster

 

 

Elizabeth - Thank you for your reply. Like your husband, I am rarely ever sick and the last time I was on antibiotics was over 22 years ago. I will let you know what we decide to do with me and how it goes. Please let me know if you get lucky and find a good Infectious Disease doc. It will be interesting to see how this plays out.

[swim]

THANK YOU!

 

A couple of things:

1. Carriage is usually shorthand for "asymptomatic carriage" and is defined as having a positive throat culture for > 14 days and not having an immunologic response
    
   
2. A rising titer (of ASO or AntiDNAse B ) is an indication of a prior GABHS infection, but to find the rising titer you must do two draws 1-2 weeks apart (i.e., have a baseline againt which to measure).
    
   
3. Most doctors don't have the two titers and use the "Upper Limit of Normal" ULN as a baseline measurement. Statistically, this works out to be a good indicator for kids with strong immunologic responses on first draw -- however, with only a single draw, you do not know if the titer is rising or falling.
    
   
4. The titer can rise even if there is no present GABHS infection. ASO rises in 46% of people 1-4 weeks post initial-infection. AntiDNAseB rises 6-8 weeks post initial-infection. In 31% of people neither ASO nor AntiDNAseB rise despite a positive throat culture.
    
   
5. A constant titer is meaningless. If significantly elevated it is possible that there is a recurrent infection but there is no reliable study indicating how to interpret a constant titer. To be safe, most doctors treat an elevated titer as if it were rising and in the absence of positive throat swab will inquire about a possible sinus, vaginal or skin infection.
    
   
6. A falling titer is also not really helpful. The rate of fall of titers is not studied. In many, AntiDNAseB can stay elevated for months.
   

In general, trust the throat culture first.

 

Bottom line, I have no idea how the doctor would have called you a carrier as you only had a single measurement and no postiive culture.

 

Regards,

 

Buster

 

 

Elizabeth - Thank you for your reply. Like your husband, I am rarely ever sick and the last time I was on antibiotics was over 22 years ago. I will let you know what we decide to do with me and how it goes. Please let me know if you get lucky and find a good Infectious Disease doc. It will be interesting to see how this plays out.