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Sore throat and ear ache. Prescribed ciprofloxacin for pseudomonas aeruginosa infection. Is this safe?

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Severe sore throat and ear ache for past few weeks, and moderate sore throat for several months (also chills, headaches, ringing ears, extreme lethargy). In past 2 weeks, have been through several different types of antibiotics with no improvement, and this morning throat culture results came back stating bacteria infection of "Pseudomonas aeuroginosa". Was prescribed Ciprofloxacin, 500 mg 2x per day for 10 days. Is this correct? Have a meeting with a new ENT specialist tomorrow afternoon and would appreciate info. on what questions to ask.

Am 43 year old otherwise healthy Caucasian male (from USA) living in Saudi Arabia for past 4 years. Pain in ears and throat has become severe, precluding much sleep, although often tired. Am also bsically incapable of eating or swallowing, and am timing pain medication to allow food 1x per day. Also, white, pus-filled pockets on back of throat and tonsils.
Also, in past few days has become very hard to speak (hurts throat), and bad breath, with occasional drool (simply because it hurts too much to swallow). I am not a dr., but when researching symptoms online I was under impression it was peritonsillar abscess, but cultre results say otherwise, as did initial dr. Took first dose of Cipro 500 approx. 7 hours ago, and was also given IV painkiller that should have lasted about 6 hours, although it wore off after about 3. Also prescribed Fevadol Plus 500 mg (2 tablets up to 3 or 4 times per day, as needed).
To this point, not really feeling better, even though it has only been 7 hourse since taking first does. Will take next does in a few hours, and another when I wake up tomorrow morning. Presumably, there should be an indication by then that it is working?
Posted Mon, 11 Mar 2013 in Ear, Nose and Throat Problems
Answered by Dr. Sumit Bhatti 1 hour later

Thank you for your query.

1. Your description does indicate a resistant sore throat since many weeks.

2. Since you also have drooling of saliva, halitosis (bad breath), diffculty in speaking, severe pain, chills, headaches, ringing ears, extreme lethargy, white, pus-filled pockets on back of throat and tonsils it is extremely important to have a direct examination of the throat, which will easily rule out quinsy (peritonsillar abscess) and establish the cause of your sore throat. You may share a close-up image here, especially if a videolaryngoscopy is done tomorrow.

3. Your throat swab culture report shows that the pseudomonas aeruginosa isolated is sensitive to ciprofloxacin. Most oral antibiotics take 24-48 hours to act. If the sore throat is very severe your doctor may consider intravenous antibiotics with addition of another sensitive antibiotic. Pseudomonas is a gram-negative opportunistic infection which has probably resulted due to weakness from a prolonged throat infection. Get a blood test to rule out any diabetes or other causes for a suppressed immune system. I recommend a second antibiotic to cover gram-positive bacteria.

4. Biofilm is an interesting concept. The Pseudomonas may be from your nasal sinuses or lungs.There may be associated allergic, fungal and mucus related conditions. The simplest example of Biofilm is the sludge or slime seen in drainage pipes or the moss seen along water channels. The Biofilm represents colonies of different types of bacteria living together like a 'city' with different micro organisms taking up different tasks or 'profession's like we do in our communities. Some of them secrete a matrix that protects them all. Due to close proximity, these bacteria share genetic material and may be genetically distinct from those that are grown in lab cultures. Hence they do not respond to the same antibiotics that they show sensitivity to in lab studies. Bacteria biofilms are notorious for antibiotic resistance and can cause other species like staph to become more resistant by exchange of genes and chemicals.

5. Supportive treatment such as anti allergics, mucolytics, steam inhalation and medicated gargles should be taken.

I hope I have answered your query. If you have any follow up queries, I will be available to answer them.

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