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Positive Strep while on antibiotics


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My PANDAS son (age 9) tested positive for strep today. Shocked to be honest...on a daily antibiotic, really just thought he had allergies, normally has very strong physcial and OCD signs of strep. Have lots of questions.

 

- Has anyone ever had a false positive test? Know false negatives are possible but what about false positive. Why might this happen?

- Immunologist has told me that if we take his daily antibiotic (amox) religiously, there should be know way he can get strep. Well, he takes his dose at the same time and has NEVER missed one so how can he have strep? I'm not sure I believe that there isn't any penicillin resistant strep. Anyone else have children who got strep while on an antibiotic?

- Do all streps lead to symptoms? Has anyone ever had a positive strep with no OCD or behavior changes? 1 1/2 years ago we had a positive strep and no symptoms (well no OCD that is - may have had some extra hyperactivity and moodiness). Again specialist believes that only certain types of strep lead to rheumatic or scarlet fever so hypothesizes that only certain strains of strep lead to PANDAS - sounds possible because body does produce very specific antibodies. Anyone else have children who got strep but didn't react certain times with OCD, rage, etc.?

 

Needless to say I am very worried today and looking for ideas, support, etc. Thanks.

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Welcome. What antibiotic and dosage is he on for the prophylactic? What did they change him to?

 

Yes, you can get strep while on antibiotics. You can also get strep when your tonsils are removed. Many on here will tell you their child contracted strep while taking antibiotics. Don't let immunologist hint that you are lying about dispensing meds. Find a different one if he remains close minded.

 

As to the question whether all strep leads to symptoms...no one knows. So, no one can tell you otherwise. It can be many factors including how fast you caught the strep or whether the prophylactic helped some but not entirely. As for the strep w/o PANDAS symptoms in the past....well... he had symptoms (hyperactivity and moodiness). With each exacerbation, the symptoms and the severity may change. Also, he may have had OCD but mild and you just didn't recognize it as OCD.

 

Many parents will look back and see their child had a previous excaerbation before the full blown explosive one.

 

Make sure to check all family members every time someone test + for strep! Change tooth brushes 48 hours after starting meds.

Edited by Vickie
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Hi, elf:

 

Yeah, our PANDAS son got strep again while on a prophylactic dose of augmentin (500 mg daily - he's 14 and about 110 lbs) and had his worst exacerbation yet. Not until we increased the dose to the "Saving Sammy" level (augmentin XR - 1000 mg twice daily) did he start to make consistent progress with no further flares.

 

I can't begin to explain the science, but our experience is like yours: the "standard prophylactic dose" of abx did not adequately protect our son from further infection. It may be that these kids' immune systems have unique vulnerabilities to GABHS that render normal abx dose / duration ineffective... or the strain that triggers PANDAS may be especially hard to eradicate. I've seen both theories.

 

You might be interested in this thread. I sure found it educational: http://www.latitudes.org/forums/index.php?...c=5520&st=0

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Oh, yes, that's the reason. The antibiotic and the fact that it was once a day. For some, amoxicillin (twice a day) works, but for the majority, amoxicillin (regardless of dose or how often) does not. When he finishes his script of Omincef, try your hardest for a different prophylactic. If the Omincef works, you can ask for that as a prophylactic. I read on here before that the only antibiotic with the longest half life that would cover a child being taken once a day dose is Zithromax. Everything else needs to be twice a day to fully cover the child.

 

Here's an article about the failture rate of amoxicillin and strep http://www.entrepreneur.com/tradejournals/.../169459644.html

 

 

He has been on amoxicillin (500 mg. 1x a day). Treating with Cefdinir (300 mg. 2x a day 10 days). Son is about 90 lbs. Thanks for your comments.
Edited by Vickie
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Well this is timely. My daughter 9 also has gotten strep while on antibiotics. We did a biaxin shot. Then 10 days Keflex. Then moved to zithromax every 4th day. We only got 2 doses of zithromax before she had strep. I realize from what I am reading (and what just happened) every 4th day of antibiotic is worthless. What is the incubation period from exposure to infection? My daughter seems to always test positive on the rapid test, and then the culture will come back negative. This time, the rapid came back negative (I have not heard about the culture). Ironically she had all the typical full blown strep symptoms this time.. vomiting, fever 101, headache. She ended up full blown scarlett fever with rash from her ears to her toes by the time we got full dose antibiotic this time 3 days later. Our normal dr. was out of town, and since we always are positive on the swab, we were told this is viral.

 

We struggle with constant illness. My daughter also has severe asthma. Ultimately we pulled her from school this year to avoid the constant exposure to germs. We had a good winter and she seemed stronger. Now that she is around children this summer, she is again constantly sick. Strep, stomach flu and now on top of the strep, she has a cold. I have a meeting scheduled with the doctor next week and I need to make a plan.

 

What is the goal of the prophylactic antibiotic? Is it supposed to prevent strep? Does our prophylactic dose need to be as strong as full strength to do anything? I don't feel like I'm being successful if she is only well if we have to hide from others. I need to manage the infections first, and then I can tackle the ocd, food issues, and rages that come. If I can't eliminte the source of the problem I'm getting nowhere.

 

Also, if her IGG levels are low, will the antibiotics not really be able to do the job correctly? She was below normal in subclass 1 and 2. I'm I just being hopeful to think that rest, sunshine, good healthy food and less exposure to germs is enough to build up your immune system?

 

Last question: She is on swim team, could she have low grade infection hiding in her body, and the stress of the race (the exertion) cause it to manifest? She spiked the fever the day after the race last week...is that coincidence?

 

Thanks. I need to figure out what to do next. My previous plan of sticking my head in the sand isn't working. I just want her to be able to play with other kids and not get sick immediately.

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I believe the time frame between contracting strep and getting a + strep test can be between 3-5 days. I've asked a few nurses that since I bring my kids in when exposed. I never know the ideal time to bring them in. I'd hate to bring them in too soon but want to catch it quick if they did contract it.

 

Prophylactic abs is to help prevent strep. But the key word is to help. It's not 100%. Also, some parents think that the anti-inflamatory aspect of some antibiotics help their kids as well.

 

As for the swim meet and a fever....could it be the pool and the chlorine doing something? I read that one parent said too much chlorine can make yeast issues worse. It may cause other issues to worsen as well. I don't really know. It does also worsen tics.

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My son got strep just about a week ago on a daily dose of azith. Treated with a shot of Rocefin (sp?) and 10 days of Omnicef. Now he's back on the azith.

 

The way our Dr. explained it to us - it is possible to get strep while on abx because of the ability to build up resistance. Being on the abx makes it far more difficult - but by no means impossible.

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Just to chime in on Vickie's correct comment. Amoxicillin 1x/day has a halflife of about 1 hour. This means that by 6 hours only 1-2% of the drug is still in the system. By 12 hours it is almost non-existant. 1x/day is not a recommended dosage for curative or prophylaxis.

 

Also, as an added complexity, a throat culture is actually a test of colonization rather than infection. You can certainly be colonized without infection and this can happen while on antibiotics. It is difficult for an antibiotic such as amoxicillin to get to the skin/mucosal surfaces. Anitbiotics rely on an intact immune system to do most of the work. The antibiotics slow down the spread of a bacteria but don't actually "kill" bacteria in the dosage typically prescribed. The dosing is aimed at helping those with intact immune systems clear an infection in about 80+% of the cases.

 

Buster

 

Oh, yes, that's the reason. The antibiotic and the fact that it was once a day. For some, amoxicillin (twice a day) works, but for the majority, amoxicillin (regardless of dose or how often) does not. When he finishes his script of Omincef, try your hardest for a different prophylactic. If the Omincef works, you can ask for that as a prophylactic. I read on here before that the only antibiotic with the longest half life that would cover a child being taken once a day dose is Zithromax. Everything else needs to be twice a day to fully cover the child.

 

Here's an article about the failture rate of amoxicillin and strep http://www.entrepreneur.com/tradejournals/.../169459644.html

 

 

He has been on amoxicillin (500 mg. 1x a day). Treating with Cefdinir (300 mg. 2x a day 10 days). Son is about 90 lbs. Thanks for your comments.

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So Buster, in our case, I would think:

 

1. We definitely in this instance had signs of infection (fever, rash, vomiting) instead of colonization.

 

2. The small amount of zithromax , once every four days, was essentially worthless as a prophylactic dosage.

 

3. According to prior information, you need to wait 21 days after antibiotics to re-culture after a previous infection to determine if you are truly clear. So even though we had a biaxin shot, 10 days keflex, and then 1 dose zithromax, four days later another, two days later full blown scarlet fever, I can't really know if this was original infection or a new infection.

 

4. Our prior treatment was for a positive rapid test, but negative culture. Could she have just been colonized at this time, not infected? She had no fever, no sore throat, but was ramping up all of her pandas symptoms so we could tell something was amiss.

 

5. If, when we are around other children, never can make it 21 days between antibiotics, would it be safe to assume, really we are probably not truly clearing?

 

I think what I'm trying to get at from reading your above post is that the antibiotics are not working for us because our immune system needs to be working to help the antibiotics...correct? Our IGG levels were too low, is that what needs to help the antibiotics fight the bacteria? Our doctor wants to help us, but doesn't know how, I have a meeting next week, and I keep printing out the research papers to hand to him explaining all this.

 

Thanks for spelling this out for me. I'm worn out from trying to get every bite of food in my daughter. I'm sad that she isn't strong enough to swim with her team tonight. I'm confused as to how to help her. I just want to to be able to be with other kids and play.

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My PANDAS son (age 9) tested positive for strep today. Shocked to be honest...on a daily antibiotic, really just thought he had allergies, normally has very strong physcial and OCD signs of strep. Have lots of questions.

 

- Has anyone ever had a false positive test? Know false negatives are possible but what about false positive. Why might this happen?

- Immunologist has told me that if we take his daily antibiotic (amox) religiously, there should be know way he can get strep. Well, he takes his dose at the same time and has NEVER missed one so how can he have strep? I'm not sure I believe that there isn't any penicillin resistant strep. Anyone else have children who got strep while on an antibiotic?

- Do all streps lead to symptoms? Has anyone ever had a positive strep with no OCD or behavior changes? 1 1/2 years ago we had a positive strep and no symptoms (well no OCD that is - may have had some extra hyperactivity and moodiness). Again specialist believes that only certain types of strep lead to rheumatic or scarlet fever so hypothesizes that only certain strains of strep lead to PANDAS - sounds possible because body does produce very specific antibodies. Anyone else have children who got strep but didn't react certain times with OCD, rage, etc.?

 

Needless to say I am very worried today and looking for ideas, support, etc. Thanks.

We had been on Amox and Biaxin or 8 days the last time my son tested positive....it shocked the H*LL out of me....but that is when we learned about PANDAS. so yes it can happen. I think Amox is useless on this strep.

Brandy

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My PANDAS son (age 9) tested positive for strep today. Shocked to be honest...on a daily antibiotic, really just thought he had allergies, normally has very strong physcial and OCD signs of strep. Have lots of questions.

 

- Has anyone ever had a false positive test? Know false negatives are possible but what about false positive. Why might this happen?

- Immunologist has told me that if we take his daily antibiotic (amox) religiously, there should be know way he can get strep. Well, he takes his dose at the same time and has NEVER missed one so how can he have strep? I'm not sure I believe that there isn't any penicillin resistant strep. Anyone else have children who got strep while on an antibiotic?

- Do all streps lead to symptoms? Has anyone ever had a positive strep with no OCD or behavior changes? 1 1/2 years ago we had a positive strep and no symptoms (well no OCD that is - may have had some extra hyperactivity and moodiness). Again specialist believes that only certain types of strep lead to rheumatic or scarlet fever so hypothesizes that only certain strains of strep lead to PANDAS - sounds possible because body does produce very specific antibodies. Anyone else have children who got strep but didn't react certain times with OCD, rage, etc.?

 

Needless to say I am very worried today and looking for ideas, support, etc. Thanks.

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My son has had strep 6 TIMES this year!!!!! last time one week ago ONE MONTH after tonsillectomy and adenoid removal. Was a shock. Still not over it. Do we ever? He has gotten strep on Anoxixillin twicw daily, also through treatmetn doses of Keflex and Omnicef. Now he has a mild allergy to Cepalosporins and we cannot give them to him. Last Monday, he was on Azithromycin 100 mg once a day and this was teh pos strep after the tonsils out, keflex, omnicef, then Azith proph. He is ony 7, cannot swallow pills. SO no XR i believe, unless soem has another idea. He weighs (weight is impt) 52-53 lbs, now on AMOX-CLAV ES (does NOT mean extra stregth, misleading but we knew that) 1200 mg a day in two divided doses, we open probiotic capsules into his drinks - sneaking in whenever we can. Trying (just decided 6 weeks of this med) bu Beth Maloney says don't stop there. So we will see. He is switchng schools (last one 1st grade treated terribly on a 504, no less) so now a smal lcahrter multiage, I can't homeschool so we are doing all we can. Play therapy, blood braws for DNAase and ASO, Immunogolulin s(only normal reulst) Sorry more than anyone asked for, I am so tired and thank you and I hope this helps soemone. Chris (Phoenix)

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