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MRSA throat infection
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MRSA throat infection

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?
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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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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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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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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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Avatar_f_tn
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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Avatar_f_tn
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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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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     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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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
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yes, Levofloxacin is another antibiotic besides Azithormycin for Mycoplasma. I think Levofloxacin is also good for prostatitis. Also if he does have Mycoplasma or another similar organism is Chlamydia pneumonia both are treated the same he can steam himself in the shower or put a hot bowl of steaming water with a towel over his head and breath in the steam to make him cough and loosen up the tightness. There are some cough meds that make you cough. Don't know if they have them there though. You can check them out at a pharmacy. Look for expectorants.
mkh9
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p.s. regarding the prostatitis, only 5-10% are from bacteria so it probably doesn't matter that Levofloxacin is good for both Mycoplasma and treating prostatitis but I just mentioned it. Most are just inflammation and other things.
mkh9
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Hey,
     thanks again, that's all great advice!  I was a little late on the juice/fruit idea anyway, he finished the Azithromycin, he only took it for 8 days.  Maybe whatever was causing the chest pain is resolving on its own, because yesterday he said the pain was better, but we'll see if that was only temporary.  I apparently misunderstood what he meant by stomach pain, the actual problem was diarrhea caused by the antibiotic:-/  He was put on Furazolidone for that, for 7 days.. hopefully that'll take care of it, I know that can get rather serious too.  As for your question, he had lost about 18 pounds in a month.. but I think he just wasn't eating, he kept saying he had no appetite.  

     His main complaint now is his prostatitis, which is getting worse.  I'm not sure why he got that originally.  It's been an ongoing problem for 3 1/2 years.  He has kidney stones, which I know can make you more prone to infection, and he may also have a urethral stricture, but that's speculation.  It may all stem from a botched cystoscopy he had 11 or 12 years ago.. he'd had a kidney stone but they gave him the cystoscopy after he was better, so he claims it was unnecessary, and a medical student did it, and they screwed up and he bled a lot, and was in serious pain for months.. and said he had mild pain in his epididymis ever after.  I'm not even clear on what happened 3 1/2 years ago.. he said he went to a hospital for something unrelated, and the doctor wanted to give him a prostate exam which apparently triggered the first bout of prostatitis.  But I know his actually is bacterial.. he's had several tests over the years that showed bacteria.  I had said the first one showed MRSA, which I thought was a mistake, because the others all showed methicillin resistant coagulase negative staphylococcus, but, he told me there was another one that showed MRSA.. he had failed to inform me of that one.  So now I'm more worried about what I've been exposed to.  He actually can't take Levofloxacin, he's had bad reactions to fluoroquinolones before.  That's a great suggestion about testing to see if he's immunocompromised, I will try to get him to do that.

     Another concern of mine, is that two days ago he told me his temperature was only 97.35, and has been for about 3 weeks.  He felt so bad that day he thought he was septic, but a doctor gave him a blood test, told him he doesn't have an infection or inflammation, and it's all in his head.  Also said "a lot of people have MRSA."  Like it's no big deal.  I had him take his pulse at that time, which was fine, 67, and his blood pressure was 123/81, which is ok but a little high for him.  Any thoughts on why his temperature would be so abnormally low if he's ok??  I was quite alarmed..
    
     He is also supposed to do another culture two days after he finishes the Azithromycin to test if the MRSA is gone.  He hates that particular doctor and wants to do the test himself and only swab his nose.. I think it's important he test his throat too, since that's where the infection was, am I right?

     Sorry for such a long post, but as you can see, it's a complicated situation that goes back years.  Thanks again for all your help!

    
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Well, they really did botch up the cystoscopy. That is terrible. Yes if he can't take fluoroquinolones the Azthro may help and anyway they don't know what organism is growing there at this point.  The temperature isn't that low. Some people naturally run low. Also, some viruses can make your temperature drop a point too. Either way it is not serious. Regarding the diarrhea, if it is due to the antibiotic he should start taking probiotics. You can get them over the counter. I billion copies is a good concentration. You can get them on line too. They should have a mixture of "good " bacteria such as bifidobacteria and lactobacillus sp. to repopulation the intestines. I hope he didn't get Clostridium difficile. Does he have bad stomach pains or anything ?  I always take the probiotics when I take antibiotics. I take Trunature brand because it isn't too expensive but there are many brands out there. You just want live active culture. Eating yogure is good that has active live culture too but he would have to eat several a day and it may not be enough since he already has diarrhea. Both would fine too. Yogurt like Yoplait or something he likes may help his appetite. Yes it would be good test his nose and re-test his throat to see if it is gone. I'm not so sure that people have MRSA. You can carry SA around normally and it won't cause a problem. MRSA is probably the same it can be carried around like in the nose and probably not cause a problem it just happens to be resistant to a lot antibiotics. However, if you immune system drops or you can transfer it to someone else, or  you wipe your nose and it gets in an area you don't want like a break in the skin on your arm it could become a problem. So, it s best not to have it. You realize that our bodies normally have billions of bacteria all over the place? On our skin, mouth, throat, even a little bit and certain types in our eyes (this is Staph epi). Our intestines have billions and vagina, have mostly anaerobic bacteria etc. But our blood, and other body fluids like spinal fluid and our brains, heart, are supposed to be sterile. So it is a fine balance isn't it? Each area has specific types that are normal to that area and in certain quantities. If the balance gets off we get sick. Anyway, I thought I would mention this. Not sure if you know this already. You sound like you are interested. But the eyes again if you get any Staph Aureaus in the eye regular or MRSA that is an infection.  Although, the body can sometimes fight it off. The tears and saliva have lysozyme so this kills bacteria. Anyway, enough said. LOL.
mkh9
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Hey,
     well, I got so worried about the low temperature because that day he was telling me he thought he might be septic, I read that if you do have sepsis, you can either have a high temperature, or, an abnormally low temperature, that's why I freaked out a little:)  He told me after the fact that his normal temperature is around 97.9.  

     The prostate improved for a day but is now bad again.  If it doesn't get better I guess he'll have to get tested for bacteria again.  He suspected all the garlic he was eating (I told him to, because again, I read some stuff about garlic and I want that MRSA dead) was irritating it, which is possible.. so I told him to lay off the garlic for a while and see if it gets better.  I'm thinking it's also possible that what's going on with his intestines is affecting his prostate.  I think he does have c. difficile:-/  Yes, he does have substantial pain, it's even been keeping him awake at night.  He had been taking probiotics during the antibiotic treatment, but he got it anyway.  I think he may have had bouts of it in the past, from other times he's been on antibiotics for his prostatitis.  The doctor told him to stop the probiotics while he's taking his Furazolidone.  He did, but it hasn't helped and he only has one day on it left.  I don't know if the doctor will want to try something else (I read Flagyl is the usual treatment), but I've told him to take probiotics if not.  He's going to take a European one called Linex.  If that doesn't help I want him to find one with s. boulardii, from the little I've read that one seems particularly effective.  I'm looking around for other remedies as well.  

     Yes, I do know we're just crawling with bacteria, good and bad:)  I didn't know all the details you do, like about the bacteria in the eye.. thanks for sharing, I do find it interesting.  I actually kind of enjoy researching these things.  A friend recently called me an "infectious disease nerd", lol.  I have read a bit about the balance of bacteria in the intestines, and everything it can affect, even mental health.. I'm starting to think most people with health problems should be on probiotics.  Have you ever seen Giant Microbes?  They're stuffed toys, in the shape of microbes.  We sold them in a store I used to work at (now closed).  I thought they were great, thought you might get a kick out of them too:)  I would post a link but I don't know if that's allowed.

     I've read a lot of people carry regular s.aureus, it's a much smaller number that carry MRSA, and I've read if you are carrying it, they do try to get rid of it, for the reasons you said.  Because it is potentially very dangerous and can be spread to others.. I'm not only determined to get rid of it for his sake, but for mine.. I don't want to catch it.  I've also told him he needs to clean and disinfect his house so he's not re-infected that way.  Anyway, thanks again for all the information:)  I will let you know how things progress.
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Yes, everything you said sounds good. I would rewash all the towels with hot soapy water, wash rags, linens that were around when he had the infection. Use 1:10 dilution or so of bleach to clean things that won't get damaged by bleach such as the handles in the bath room sink and toilet, bathroom faucets, other, sinks, and you can use comet to clean the sink and bleach and the toilet of course. But If there is granite tops you actually can use a light small percentage of bleach for that. I don't have them yet so I don't know what type of cleaner they have for them. Fomites (handles and door knobs etc.) are important and the laundry. As for C. difficile that is the same you have to really clean everything down for that. Metronidazole is right. Also, if it becomes resistant to that they use Vancomycin.  And, believe it or not and this may gross you out there is a new procedure that if  you cannot respond to treatment any more then you can get a fecal transplant. I don't know if you are barfing or laughing but it is true and it works. What they do is find a donor usually a family member or wife or girlfriend , anyone they know doesn't have hepatitis , or HIV any thing where you are going transmit a disease plus haven't ever had C. difficile and they will test you for all that. Then they either take a sample of your stool and the person gets an anema  or they do an endoscopy.  It replaces the normal bacterial flora and it works. It is still a bit under research but it does work. So, something to think about if all else fails. I hope it doesn't come to that. C. diff often recurs. Be careful you don't get it yourself. Wash you hands and wear gloves when cleaning up and maybe a mask because the spores can float around. Use bleach. If I remember correctly the disinfectant wipes dont' work on the spores only bleach does. As for the S. aureus yes you have S. aurues in various places on the body. The skin can have it, the vagina , the throat, and stool, the nose can carry it,. But NOT the eye, and not in large numbers anywhere only a colony or two. you can carry it asymptomatically in the nose or you can get sinusitis. It just depend on how toxigenic the strain is and how you immunity is etc. MRSA is the same bug it just has become resistant. You should have been a microbiologist. I used to have a T-shirt that said "microbiologists have culture" LOL.
mkh9
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p.s. to be clear the eye can have Staph epi but not (none) Staph aureus.
bye,
mkh9
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p.s. Also, regarding C.difficile the alcohol hand sanitizers don't work at all either.  Use soap and water to wash your hands. Same for him.
mkh9
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