INFECTIOUS DISEASES
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MRSA throat infection
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by LD2468, Jan 04, 2014
Hello,
     my boyfriend, who lives in another country, has been sick for a few weeks.  It started with what seemed to be a cold or flu, but he has been getting worse.  His throat has been very sore.  A couple weeks ago a doctor gave him antibiotics without doing a test, the prescription was for 5 days, unfortunately he doesn't remember which antibiotic it was.  His throat was still hurting and he said he could see pus, so I told him he should get tested for strep.  He did, but, the results were worse than strep - his throat is infected with MRSA.  He's had other symptoms as well; pain in one lung, and in his chest, shortness of breath, and headaches.  For a while he was having pain in his stomach and vomiting.  He'd had a chest x-ray a couple weeks ago for his lung, the doctor thought it looked ok.  The doctor he just went to was an endocrinologist.  He went to her because of some tests with strange results, low calcium and some blood gas tests that were off, but the calcium was tested again and is now normal, but he has had extreme anxiety and she did diagnose him with hyperthyroidism.  But she is also trying to treat his MRSA infection, and I'm not sure the antibiotic she chose will do the job.  He was prescribed Azatril (Azithromycin) for only 4 days.  It is shown to be susceptible to that antibiotic, but will only 4 days do for something as serious as MRSA??  I hope someone can help with this, and if anyone could tell me a better antibiotic choice, as well as length of prescription/dosage, it would be greatly appreciated.  I want him to go to an infectious disease specialist, but it is hard to find a good doctor where he lives.  Some other antibiotics it's shown to be susceptible to are: Cipro, co-trimazole, Bactrim, Doxycycline, Gentamycin, and Clindamycin.  I'm thinking Bactrim would be a good choice?
Member Comments (17)
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by Caryopteris, Jan 04, 2014
That is the same drug as a Z-pak, which is always given as six pills (two the first day).  

Just because his bacteria is resistant to methacillin doesn't mean it can't be cured by a Z-Pak.  I think his doctor is handling it fine, but be aware this drug continues to treat for a long while after it is started, so I don't know when he will stop being contagious is my only question.  They say it is a long half-life.  So to me, it always seems like it has a delayed reaction compared to other antibiotics.  It's in your body, but it's working on the infection after finishing the pills.  
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by LD2468, Jan 05, 2014
Hi, thank you for your response.  I was aware that it's usually given as a shorter prescription than other antibiotics, and that gave me the idea that it was not for serious infections, perhaps I was wrong.  I have no personal experience using it, thanks for telling me about yours.  I just wondered if it was an adequate length of time for MRSA, because generally that's treated with weeks of antibiotics if it's internal.  I'm having a hard time finding much information about how a MRSA throat infection is treated, however.  I did read on drugs.com that pneumonia caused by staph should be treated for 7-10 days with Azithromycin, with the first two days by IV.. and I am worried that it's spread to his lung (which he says is hurting).. so still concerned that 4 days isn't enough.  I need to read a bit more and get info from him about the dosage he's on.  Thanks again for your answer!
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by mkh9Blank, Jan 06, 2014
Well, to me your question is complicated. First Azithromycin is not the drug of choice but MRSA could be sensitive to it. Did he get this in the hospital or at home (in the community)? if so then the drugs of choice are dependent on whether he has pneumonia or not or if it is just in the throat. Pain in the lung sounds like pneumonia but then his Xray was ok? So, I would say he should see an infectious disease specialist if he isn't getting better. Generally, for community acquired pneumonia they do tests in the lab to see what drugs the MRSA is sensitive to.  If it is sensitive to clindamycin then they give a combination of vancomycin and linezolid or linezolid and clindamycin. So, it depends on what the lab tests show and whether he actually has pneumonia or not. You should not have intimate contact with him until they say he is definitely healed.
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by LD2468, Jan 07, 2014
Hi,
     thank you so much for your response!  He had a throat culture, and susceptibility testing, and it was shown to be susceptible to Azithromycin, and Clindamycin, as well as some others in my original post.  

     I actually don't know where he got it.  He had gone to a hospital just because he felt so bad from his initial illness.. I don't know if he already had it at that point.  He said they did no invasive tests or procedures there.  He had a family of Syrian refugees staying at his house for a while, who had been living in a refugee camp, and one of their children got sick, so I wondered if it was from them, but he said he got sick before their son did and doesn't think he had MRSA.  So I really don't know.  He's had chronic prostatitis for 3 1/2 years, that bacteria was shown in the first test to be MRSA, but in 5 other later tests the result was methicillin resistant coagulase negative staphylococcus.. so I figured that first test was just a mistake.  He thought it was related, but I thought not.  That one I'm more concerned about my exposure to.. I'm not currently in the same country as him so won't be exposed to his MRSA.

     He says he still has pain in his lung, and basically his whole body, but thinks he doesn't have pneumonia because he's not coughing.  They didn't culture his sputum, just his throat.  He went to see another doctor yesterday, who told him to continue the Azithromycin for 8-10 days, but doesn't seem to think MRSA is a serious problem.  He went to the hospital a couple days before that and they didn't take it seriously either.  He did say the endocrinologist that prescribed the Azithromycin told him he should be on Vancomycin or Teicoplanin.  But another doctor apparently told him he shouldn't because Vancomycin is harmful to the liver.  Maybe they think his infection isn't severe enough.  Thank you so much for telling me the proper antibiotics to use, you were very helpful.. now it's just a matter of finding a doctor over there that will do that, in the event he doesn't improve, or gets worse.  Do you think 8-10 days of Azithromycin is adequate if it actually is only his throat, and not pneumonia?  (Or even if it is pneumonia and the doctors just won't give him anything else).
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by mkh9Blank, Jan 07, 2014
You are welcome. Yes if it is just in the throat that should be enough time. And I'm glad if the MRSA was sensitive to Azithro even if it isn't the drug of choice. It is a good drug generally speaking.  If he does have pneumonia the drugs I mentioned are the ones they now use even though they are tough on the liver because for pneumonia you can get resistance and other variant strains that develop. They used to just use Vancomycin but there are resistant strains of it and toxins etc. I can go into it if it comes up. It doesn't sound like that is the case here.  Let me know how it goes.
take care,
mkh9
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by LD2468, Jan 08, 2014
Hi again,
     well.. I'm not sure what's going on now.  His throat is feeling better.. I think it was actually starting to feel better before he even started the antibiotic, but now he's saying his lung hurts more.  And still has pain all over.  I've been thinking maybe the pain in his lung is pleurisy?  But I think that would have been seen on the x-ray too.  I asked if he could see a pulmonologist but it's a holiday there now and basically nobody in the country is working all week.  He did find an infectious disease specialist in another city, he's going there for a consultation, but not till next week.  I will let you know what they say.

     In the meantime I stumbled upon this research (I was about to tell him not to eat sugar because bacteria feeds on sugar, and looked it up to make sure I remembered that correctly), saying that giving sugar with antibiotics can actually kill persister bacteria because instead of going dormant they stay awake to eat the sugar, and with it the antibiotic.  So.. it's still new research and only tested on mice, and intravenously, but do you think it would be totally crazy to tell him to eat some fruit or drink a glass of juice (they specifically say fructose) with his Azithromycin?  I'll post a link so you can read it yourself.. you may have already, being a microbiologist, but in case you haven't:

http://www.livescience.com/14124-sugar-improves-antibiotic-treatment-persistent-bacterial-infections.html

I thought that was interesting anyway.  Hope I'm not bothering you with my out there questions, I'm just throwing anything I find at this MRSA (I also have him eating garlic because of what I've read about that vs. MRSA).  Thanks again for all your help, it really is greatly appreciated.  I will let you know what the infectious disease specialist says, take care.
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by mkh9Blank, Jan 09, 2014
I haven't read the article yet but generally a high dose of sugar or salt would possibly kill bacteria but it have to be really high and that would make you sick. Also, bacteria do feed off of glucose (most do not all). Remember, just because they did it in mice doesn't mean it will work on humans or cause the same reactions. They can give mice a really high dose which could kill the mouse just to see if it would kill the bacteria. It is not worth having him try this trust me. Anyway, a healthy diet is good. I am not a fan of orange juice or juices as they just are calories that don't really do that much. A piece of fruit would do a better job it has more nutrients.  The sugar or fruit juice won't do anything to the Azithromycin. Anyway, good that he is seeing a specialist for the lung. Any good doctor can take an Xray and see if there is pneumonia on the lung. Pleuracy hurts when you breath in and it feels like very sharp stabbing pain usually in the ribs not in the lung area.   It may be bronchitis. This would be a secondary infection. It may not be MRSA it could be mycoplasma which my need another antibiotic or the MRSA could go to the lung in which case it can be serious and he would need the antibiotics I mentioned if it is pneumonia . It may not be. Does he have a fever? Chills, hurts to breath in? Hard to get enough air? A cough? Again they would see pneumonia on an Xray. It could be something else. I hope it isn't. But if it is I hope they hit it hard.
Hope this helps.
mkh9
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by LD2468, Jan 10, 2014
     Ok, I won't make my boyfriend eat a 5 pound sack of sugar, lol.  I just thought maybe a little bit of fruit or juice with the Azithromycin might be worth experimenting with, but didn't want to make things worse either by feeding the bacteria.  He could probably use extra calories actually, he's had no appetite and has been losing weight.
    
     He actually hasn't arranged to see a pulmonologist.  He was going to a gastro-enterologist yesterday because his stomach is hurting again.  I figured it's from one of his medications (he's also on drugs for his anxiety now), but he said it was hurting before too.  Haven't heard yet what they said.  His prostatitis is starting to flare up again too.. he's just a mess.
    
     He's not sure the pain is actually in his lungs.. he's said he still has some pain on the right side of his throat, and somewhere lower in his chest, he said maybe his esophagus but also around his heart.. maybe he's talking about his bronchial tubes, hard to say.  He hasn't been coughing, he has no fever or chills, but a lot of chest pain, steady though, not worse when he inhales or coughs, and he does feel like he's not getting enough air.  Also the blood gas tests they did a couple weeks ago seemed to indicate he wasn't getting enough air, but they only repeated the calcium tests, nothing else.  Do you mean a secondary infection caused by the antibiotic, or one that was there already?  I read about mycoplasma pneumonia because of what you said, which they said is often the cause of walking pneumonia, and it does sound a bit like that.. it started before he got the antibiotic though, and before the MRSA throat infection was diagnosed.  And this all started with what I thought was a virus.  Do you think he should get a sputum culture, and is that even possible when he's not coughing?  Thanks again for all your advice, you've been very helpful, which is very much appreciated.. it makes this a lot harder that he's in another country and I can't talk to the doctors there.
  
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by mkh9Blank, Jan 11, 2014
I wouldn't worry about him having a glass of orange juice if he wants it. That won't feed the bacteria. Regarding the possible secondary infection which could be Mycoplasma pneumonia it is usually after a virus not after a bacteria but it can be anytime you get run down. It is more common after a virus though. You don't need to culture it, they do PCR on it. But most doctors treat by the symptoms or empirically. They would given him Azithromycin or maybe there is a combination they can use to treat the prostatitis and Mycoplasma such as Levofloxacin. I would have to look it up but I will lose my message if I do. Do you know why he has the prostatitis? It sounds like he may be immunocompromised. Has he been checked for this? Done any blood tests to see if he is low in Immunoglobulins or CD4/CD8 ratio etc. and a complete blood count? It can't hurt to do a sputum culture but this won't be for looking for Mycoplasma they don't culture for it that way. They usually do PCR if they are going to do that. It is hard but not impossible to culture just less sensitive.  The sputum culture would look for Streptococcus pneumonia and other problems in the lung. But he doen't have a fever. It does sound more like a "walking pneumonia" or pleuracy or a bronchitis. But maybe they should check his heart to make sure if they haven't and also ulcers can cause a lot of problems too. So an upper GI or gastroscopy. How much weight has he lost and in what amount of time?
I hope I answered all your questions.
mkh9