Antitiotics resistant soar throat

[fulu]

My daughter (25 years old) has swelling and inflammation in her throat and tonsils for more than 6 months and is taking her 6th course of antibiotics (penicillin, Keflex, 3 courses of Augamentin, and the 6th of Levaquin), but her throat still looks raw.  Besides antibiotics, she was given Kenalog twice between January and June 2005.  Her throat culture and blood test are negative.  Her internal medicine doctor and ENT cannot figure out why her throat still raw.  On May 28 her ENT gave her Prilosec OTC.  But Prilosec OTC makes her feel sick and she quit after 4 days.

Could you please enlighten me as to any treatment was missing? And what is your impression of her illness?  Is she having some complication from her delayed treatment on her Strep throat (Rx started 11 days after onset)?  She developed rash in November 2004,and fever, severe headache and soar throat in December or early January, but her first antibiotic (Penicillin) was not given until the end of January.  Thank you very much.  

[National Jewish]

The sore throat may or may not be due to an infection.  If your daughter’s tonsils are truly enlarged, at age 25, she may need a tonsillectomy.  Before that decision, however, she should be given a trial of another proton pump inhibitor that she might tolerate better than Prilosec® (omeprazole).  She should see an infectious disease specialist to check her immune status.  Also this specialist could check to see if this could be an unusual infection that is resistant to the antibiotics she has been given.

No, I do not believe this is a response to the initially delayed treatment.

[bactitech]

I am a microbiology technologist. We're the ones who read out the cultures sent by the doctor. I am NOT a doctor.

However, I can't help but wonder why she's had six rounds of antibiotics with negative cultures. What are they treating?

Have they taken fungal cultures? After all these antibiotics you can get fungal overgrowth. Has she seen an infectious disease doctor? That might be the next step.

Also, it is important to find out exactly what organisms are included with the type of order submitted. Every lab is a bit different. For example, our "strep screen" culture ONLY includes group A beta strep. Some labs include ANY beta streptococcus (there are others besides group A). So, if the doc is ordering strep screens, it is worth checking to see what is covered.

Also, a "throat culture" order will produce different results in different laboratories. We do not culture for Hemophilus sp. in our throat culture; some labs do. Again, it's worth the doc giving the lab a call and asking to speak with their chief microbiologist/supervisor. Anything special can also be lined up ahead of time if they want to culture her again.

What happens when she stops ALL antibiotics?

Have they talked about referring her to a GI doc and having a look down her esophagus? Perhaps answers will come from this procedure.

Good luck.

[fulu]

Thank you for your input.  Her internal medicine and ENT cannot figure out why her throat still looks raw after so many rounds of antibiotics.  Her ENT is now trying to rule out heart burn and postnasal drip.  A CT of sinus was just ordered by her new ENT and after 6th course of antibiotics, she was not given any antibiotics.  She had a lot of pain in her throat and head when her antibiotic was finished in the past; therefore, her physicians kept giving her antibiotics.  However, she had a lot of reaction to her last antibiotics (Lavequin), such as diarrhea, rash, severe headache, insomnia, nausea, vomiting, no appetite.

[bactitech]

Levaquin is one of the family of quinolone antibiotics. Its generic name is Levofloxacin.

Your daughter may also react this way to future prescriptions for Ciprofloxacin, Norfloxacin, Ofloxacin, Gatifloxacin (a new one). There are other "floxacins" also. Have her question her doc if he put her on any of the quinolones again. I'm not sure what constitutes an allergy in this class of antibiotic.

If she continues to have diarrhea, even up to one month post-antibiotic (of any sort) she should be tested for Clostridium difficile toxin in her stool. C. diff. can cause pseudomembranous colitis after courses of antibiotics. Outpatients have less of a chance of getting this than inpatients, but it should be kept in mind if she has nasty mucoid diarrhea in the future.

http://www.aboutibs.org/Publications/CDifficile.html

Most labs perform C. diff testing at least once per day (in large facilities). Smaller labs may send this testing out. The tissue culture assay referred to in the above URL is getting harder to find, as it is lengthy and requires higher level of personnel to perform. We stopped doing it a couple of years ago. We now perform one of the more rapid assays and do two batches of testing a day.

Hope they get to the bottom of your daughter's problems. Glad she's getting a breather from the antibiotics. Too much of a good thing sometimes is NOT okay.