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Use of Abx and Strep Resistence


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I feel like a first grader sitting in a college class given that I am new to all of this and keep having questions that have probably been covered so I apologize in advance. My wife and I recently received the PANDAS diagnosis for our 4 year old son. We are working toward understanding the treatment options, but it's clear that Abx is a primary route for treatment and it can include some long term use of Abx. Can Strep A develop a resistence to these Abx over time? I am not questioning the use of Abx just curious if this is a concern for treating PANDAS and how it is addressed. My guess is that the Abx's are alternated or rotated in some way to avoid the resistence issue. Any feedback would be great. Thanks!

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I feel like a first grader sitting in a college class given that I am new to all of this and keep having questions that have probably been covered so I apologize in advance. My wife and I recently received the PANDAS diagnosis for our 4 year old son. We are working toward understanding the treatment options, but it's clear that Abx is a primary route for treatment and it can include some long term use of Abx. Can Strep A develop a resistence to these Abx over time? I am not questioning the use of Abx just curious if this is a concern for treating PANDAS and how it is addressed. My guess is that the Abx's are alternated or rotated in some way to avoid the resistence issue. Any feedback would be great. Thanks!

 

At least on this forum, it seems that antibiotics are often only changed if needed. For example, if a certain antibiotic that was initially helpful in treating symptoms (eg. Amoxicillin) is no longer working, then the general advice is to step up to something more clinically effective. For those of us who are already on "big gun" antibiotics (eg. Augmentin or Azithromycin), well, to be honest, most of us are reluctant to "mess with what is working" and go back to antibiotics that didn't work for us in the past...or even try something new which might not work.

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By no means can I discount the risks of long term abx. It's not something I wanted to do initially. I was much more inclined to just treat as needed. But then my son developed chronic strep in his adenoids. He'd go on 10 days of amoxicillin and get better. Then go off and Pandas symptoms would ramp back up, lymph nodes would swell. Back on 10 days amox...repeated this cycle for 4 months - which was probably far riskier in terms of teaching that bacteria to become resistant to amox than if we'd just stayed on the amox for 4-6 weeks non-stop and eradicated it fully.

 

After seeing my son go up and down for most of 1st grade, we went on long-term zith, then switched to augmentin because amox no longer worked. You live with this stuff long enough, bacterial resistance becomes the least of your worries.

 

It's more the improper use of abx - people stopping them before the infection is fully gone, giving livestock a daily dose with every meal...70% of the antibiotics used in this country are given to livestock.

 

Also, many Pandas kids who do immunology workups find that they have some degree of an immune deficiency. In my son's case, he failed to produce antibodies to 13 out of 14 pneumonia strains that he was vaccinated for. His body does not know how to attack strep with the same ferocity as the normal kid. So antibiotics give him support. His colds no longer automatically deteriorate into something worse.

 

As I said, I'm not trying to minimize the risk. It's just that your perspective changes and when it's time to pick your poison, Pandas symptoms vs. abx risks, the scales usually tip unanimously in favor of abx.

 

As for the 1st grader feeling, please don't ever worry about that. I've been in the battle for 2 years and still have much to learn. And sometimes it isn't until you try to explain something to someone else that something really sinks in. Also, this forum isn't like many other forums where you'll see a lot of hankies and "woe is me". We do support each other - don't get me wrong - but we are a lot of geeks who like to share research papers and arm each other with knowledge. Ask away.

 

Laura

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There are many, many examples here of kids being on abx for extended periods and still, when necessary, responding to it later on down the road. For instance, Sammy Maloney took Augmentin for more than 4 years all told, but he still reaches for it now, several years later, if exposed to strep, and it still does the trick. And RF sufferers have traditionally been given years and years of abx.

 

Another "cinch" for me was that our pediatrician, a "non-believer" in PANDAS, has continually agreed to renew our abx prescription; she's helping us, she says, under her "first, do no harm" Hippocratic oath. I even asked her if we should have liver levels checked, etc., as DS has been taking Augmentin since October 2009. She said no, that she has no concerns about any negative ramifications from either the medicine or the dosage, despite the length of time he's been taking it.

 

I don't know if there's a possibility that abx resistance has been overstated in some cases, or if certain ones are less likely to foster resistance than others, or what.

 

As LLM has already said, however, picking one's battles becomes an everyday conundrum in the PANDAS world. I like to think that sticking with an abx that seems to be working with regard to the PANDAS leaves us with several others in reserve should any resistance develop, and I can't imagine DS getting through his days right now without their assistance. It would seem cruel to remove them at this point.

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