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Nausea, lack of weight gain, taken four doses of clarithromycin. Is it safe?

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my daughter has had 4 doses of 250mg clarithromycin in past 4 mths. First in
April and May, 2012 for suspected hypylori treatment, and then for bronchitis and a sinus in fection during travel. Now her white blood cells appear to be towards the low end of normal at I think aprox 4.0. Is this many mnthly doses safe in a 6 1/2 yr old ?? She is also developed in the last 2 mths sensitivitive taste buds, dislike for foods she may have liked before, and sensitive to heat even tepid showers first thing in am can make her feel nauseaus. She is still getting evaluated for lactose intolerance and fat intolerance or gallbladder check with a hydascan. This all started with less appetite in nov 2010 after a visit to S Africa. Then she had nausea starting in aug, 2011 with milk. Then she had 2 er visit in Feb, & March, 2012 with suspected stomach bug. The nausea did not leave after the 2ns one in marh. We were in california where there was an epidemic of norovirus. My daughter also had a gastroscope in april, 2012 due to ongoing nausea which revealed gastritis and white nodules or bumps in her stomach. Her duodenum, osopageal biopsies were all normal and did not reveal any eosinophillic disease or any pathogen. She was treated with 2 mths of clarithromycin for 2 consequtive mths (250 mg) twice daily for 10 days and 1 tablespn of peptobisdol for 1wk and 20 mg prilosec once daily which we did not continue after 2wks. She has also had severe constipation back-up in the colon and needed 2 cleanouts and remains on 1- 1 1/2 cap of miralax daily and 1/2 cube of exlax three times per week to evacuate. she apparently grew in height quicker than her weight gain. her height is 46 1/2 inches and 43 lbs. A gastroenterologist thought she may have lost her fat pad in her lower back causing her lower colon to drop and possible impingement on spine causing nausea. an upper GI barium test was done to rule out superior mesenteric artery syndrome. The test showed the duodenum, stomach to be normal with no rotation. The barium flowed thru the artery, oesophagus, into stomach and out duodenum at a normal rate. A mri of her Brain has been done and was completely normal. My daughter suddenly looked thin and lankey as if she lost her toddler fat! she cant tolerate more than 2 oz of pediasure or any dairy the dr wants her to take without two lactaid chewables, and chewable digestive enzymes I give her. She has the enzymes with all food for especially for hidden fats. She cant tolerate any added oils fats, butter etc. she can tolerate fats in almonds, pistacios. Stool cultures and blood tests for bacteria, giuradia and parasites revealed none. We did a 1 dose parasite cleanse with a product called vermox, due to the fact we visited south africa in 2010. Recent blood work showed Tsh, but normal T4 and low white blood cells. Our GP will recheck in 3wks. My daughter is eating a little better but does get alot of bloating, and fullness after a full day of trying to eat as much as she can. She may have only gained 1 lb in two weeks. Can any drs provide any insight, explanation or direction into this ongoing nausea, and lack of weight gain that my daughter has ?? please, please, help !! this has been a nightmare for 6mths ..thanks
Posted Sat, 1 Sep 2012 in Child Health
Answered by Dr. Taher Kagalwala 2 hours later

I am indeed shocked by the pain your daughter and you parents have undergone in the last six months. The degree of aggressive investigations and the treatments would have caused so much trouble to her, and to both of you. Thank you for approaching this forum to seek answers.

It appears that the doctors are considering malabsorption conditions (where the child cannot absorb the nutrients from her gut and as a result, begins to lose weight) and also infections and infestations as a cause of all the problems.

Intestinal tuberculosis can also cause weight loss and loss of appetite, and since you were in South Africa, (which is a low endemic zone) this diagnosis should also be considered. They seem to have looked for and ruled out pancreatic enzyme deficiencies ... but I am not too sure. Please ask if cystic fibrosis or pancreatic enzyme deficiencies were considered or not.

I would think of fat malabsorption as a cause (as explained above) but her constipation is unusual. Children with fat malabsorption tend to have large, frothy and foul-smelling stools, so perhaps this might be something else.

They might also want to consider irritable bowel syndrome, but the child's very young age goes against this diagnosis.

My suggestion: revert to me please with the replies to my posed queries, and we will take it from there.

Thank you once again.

I am,

Dr. Taher
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