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Suggest Remedy For Persistent Infection In Nose
Question: I have a difficult to treat infection in my nose that has continued over several months, on and off.
I have been treated with amoxicillin three times with Otocomb Otic (the first two times it worked, the third it didn't, in mid August, then early September, then mid October).
Then I was treated with a high dose of Augmentine Plus with bactroban in late October (1000 mg/62.5mg) for two weeks, which helped while I was taking it, but the infection returned a week after I finished the antibiotics.
I was then given a course of flucloxacillin in mid November, which didn't work at all, changed to Levoflaxin for one week, which also didn't work. I was tested the day after the Levoflaxin course finished (last Wednesday 3rd December) and the swab said I was clear of infection. I originally was diagnosed as having a staph infection in the nose, but then the ENT I saw in Spain diagnosed me as having "bacterial rhinitis" (which I didn't agree with as I had no runny nose or symptoms of rhinitis). I have only had swelling of the nostrils, and extreme pain.
But I am still in extreme pain. The first ENT doctor referred me yesterday onto a neurologist who said I might have minor nerve damage from all the infections, and prescribed me Neurontin. I wasn't sure about this diagnosis so saw a different ENT specialist for a second opinion.
The second ENT doctor believes I still have a staph infection that keeps on returning, and put me on a Flucidin cream for 10 days (but with no oral antibiotic). So far put the cream in for two days but no improvement. Very concerned - should the flucidin be accompanied by an oral antibiotic (such as Rifampin)?
Could having a swab taken the day after finishing a course of antibiotics mean the negative reading for infection was false? Would it be safe to try another course of Augmentine Plus (as this is the last antibiotic that actually worked)
I am desperate! Not sure what to do because most of the doctors I am seeing seem to hopeless. I just want the pain to stop! I would also like to ask if an MRSA would show up a day after finished Levoflaxin and Bactroban? Back in my home country of Australia I work with people with disabilities, one of whom has an MRSA. I believe I was not given proper protection when I worked with him - no mask or apron, only rubber gloves.
That said, the results I received yesterday said I was negative for infection, but the test WAS taken only the day after finishing antibiotics. And I am still in paint with nasal swelling.
XXXXXXX
I have been treated with amoxicillin three times with Otocomb Otic (the first two times it worked, the third it didn't, in mid August, then early September, then mid October).
Then I was treated with a high dose of Augmentine Plus with bactroban in late October (1000 mg/62.5mg) for two weeks, which helped while I was taking it, but the infection returned a week after I finished the antibiotics.
I was then given a course of flucloxacillin in mid November, which didn't work at all, changed to Levoflaxin for one week, which also didn't work. I was tested the day after the Levoflaxin course finished (last Wednesday 3rd December) and the swab said I was clear of infection. I originally was diagnosed as having a staph infection in the nose, but then the ENT I saw in Spain diagnosed me as having "bacterial rhinitis" (which I didn't agree with as I had no runny nose or symptoms of rhinitis). I have only had swelling of the nostrils, and extreme pain.
But I am still in extreme pain. The first ENT doctor referred me yesterday onto a neurologist who said I might have minor nerve damage from all the infections, and prescribed me Neurontin. I wasn't sure about this diagnosis so saw a different ENT specialist for a second opinion.
The second ENT doctor believes I still have a staph infection that keeps on returning, and put me on a Flucidin cream for 10 days (but with no oral antibiotic). So far put the cream in for two days but no improvement. Very concerned - should the flucidin be accompanied by an oral antibiotic (such as Rifampin)?
Could having a swab taken the day after finishing a course of antibiotics mean the negative reading for infection was false? Would it be safe to try another course of Augmentine Plus (as this is the last antibiotic that actually worked)
I am desperate! Not sure what to do because most of the doctors I am seeing seem to hopeless. I just want the pain to stop! I would also like to ask if an MRSA would show up a day after finished Levoflaxin and Bactroban? Back in my home country of Australia I work with people with disabilities, one of whom has an MRSA. I believe I was not given proper protection when I worked with him - no mask or apron, only rubber gloves.
That said, the results I received yesterday said I was negative for infection, but the test WAS taken only the day after finishing antibiotics. And I am still in paint with nasal swelling.
XXXXXXX
Brief Answer:
Deep nasal swab. Biofilm. VISA , VRSA. Fungal culture, PCR.
Detailed Answer:
Hi,
Thank you for your query.
1. Get a deep nasal swab for detecting MRSA.
2. Yes, if you have recently stopped antibiotics, you may get a negative report.
3. You may have 'Biofilm' formation. This would explain the recurrent infections.
4. If you have been in close contact with an MRSA patient, you may be an MRSA carrier. Prophylactic treatment with Vancomycin or Rifampicin is a good idea. Also remember that VISA (Vancomycin Intermediate-resistant Staphylococcus Aureus) and VRSA (Vancomycin Resistant Staphylococcus Aureus) also exist.
5. Get a plain Sinus CT Scan done and upload the images. Upload the swab reports. Also send the swabs for fungal culture and bacterial PCR (Polymerase Chain Reaction) test that is more sensitive.
6. You need anti-inflammatory medication and an investigation as to the distribution and cause of the severe pain.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Deep nasal swab. Biofilm. VISA , VRSA. Fungal culture, PCR.
Detailed Answer:
Hi,
Thank you for your query.
1. Get a deep nasal swab for detecting MRSA.
2. Yes, if you have recently stopped antibiotics, you may get a negative report.
3. You may have 'Biofilm' formation. This would explain the recurrent infections.
4. If you have been in close contact with an MRSA patient, you may be an MRSA carrier. Prophylactic treatment with Vancomycin or Rifampicin is a good idea. Also remember that VISA (Vancomycin Intermediate-resistant Staphylococcus Aureus) and VRSA (Vancomycin Resistant Staphylococcus Aureus) also exist.
5. Get a plain Sinus CT Scan done and upload the images. Upload the swab reports. Also send the swabs for fungal culture and bacterial PCR (Polymerase Chain Reaction) test that is more sensitive.
6. You need anti-inflammatory medication and an investigation as to the distribution and cause of the severe pain.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you,
I have already had a CT scan of my sinuses that didn't show anything. My sinuses are clear. The latest swab also was negative but as discussed, this was taken the day after antibiotics.
I have been put on a ten day course of Fucidin (as of yesterday) by the second ENT doctor.
Is it safe to stop this after 2 days of treatment (so I can get the swab as soon as possible) or do I have to finish the course? I was recommended to use it for ten days.
He started me on this even though I asked for a swab first. I have had a lot of trouble here getting doctors to test me.
I have not had any runny nose or congestion, only swelling and pain during this infection.
Also how long should I wait after I finish the antibiotics to get the test? As I am due to leave my current location soon I want to find out when is earliest I can get this swab taken without the results being potentially comprimised.
Thank you for your assistance. XXXXXXX
I have already had a CT scan of my sinuses that didn't show anything. My sinuses are clear. The latest swab also was negative but as discussed, this was taken the day after antibiotics.
I have been put on a ten day course of Fucidin (as of yesterday) by the second ENT doctor.
Is it safe to stop this after 2 days of treatment (so I can get the swab as soon as possible) or do I have to finish the course? I was recommended to use it for ten days.
He started me on this even though I asked for a swab first. I have had a lot of trouble here getting doctors to test me.
I have not had any runny nose or congestion, only swelling and pain during this infection.
Also how long should I wait after I finish the antibiotics to get the test? As I am due to leave my current location soon I want to find out when is earliest I can get this swab taken without the results being potentially comprimised.
Thank you for your assistance. XXXXXXX
Brief Answer:
Wait 4-5 days before repeating the swabs.
Detailed Answer:
Hi,
Thank you for writing back.
1. A clear scan is good.
2. Fucidin is a bacteriostatic. You can stop it.
3. Most antibiotics achieve maximum concentrations for 8 to 12 hours.
4. Hence you can wait for a 4-5 day at the most before getting the swabs.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Wait 4-5 days before repeating the swabs.
Detailed Answer:
Hi,
Thank you for writing back.
1. A clear scan is good.
2. Fucidin is a bacteriostatic. You can stop it.
3. Most antibiotics achieve maximum concentrations for 8 to 12 hours.
4. Hence you can wait for a 4-5 day at the most before getting the swabs.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thank you for your response.
I just would like to know what this means -"Biofilm formation" and also "PCR (Polymerase Chain Reaction".
It is Tuesday evening here - would Friday be too early to get the swab done? It is difficult because GPS are not open on the weekend here in Spain. But if need be I could go to a hospital on Saturday or Sunday.
When you refer to antibiotic maximum concentrations do you mean after you've started the antibiotics?
Thank you
I just would like to know what this means -"Biofilm formation" and also "PCR (Polymerase Chain Reaction".
It is Tuesday evening here - would Friday be too early to get the swab done? It is difficult because GPS are not open on the weekend here in Spain. But if need be I could go to a hospital on Saturday or Sunday.
When you refer to antibiotic maximum concentrations do you mean after you've started the antibiotics?
Thank you
Brief Answer:
Biofilm is a recent concept. PCR tests are widely used.
Detailed Answer:
Hi,
Thank you for writing back.
1. Biofilm is a relatively new concept in medicine where micro-organisms such as bacteria and fungi coexist as a colony where different microorganisms play different roles as in a community. This sludge has high resistance to medication due to the synergistic coexistence of multiple microorganisms. In fact the cultured microorganisms in the lab and their sensitivity to medication may be different outside and inside the biofilm.
2. PCR is a DNA amplification and detection test that is highly accurate. It is widely used.
3. The time duration between the last dose and swab tests seems sufficient.
4. The maximum antibiotic concentrations are achieved after starting the antibiotic. They peak and last for a few hours after administration. Antibiotics remain in the system for longer durations but not in the concentration required to destroy the microorganisms.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Biofilm is a recent concept. PCR tests are widely used.
Detailed Answer:
Hi,
Thank you for writing back.
1. Biofilm is a relatively new concept in medicine where micro-organisms such as bacteria and fungi coexist as a colony where different microorganisms play different roles as in a community. This sludge has high resistance to medication due to the synergistic coexistence of multiple microorganisms. In fact the cultured microorganisms in the lab and their sensitivity to medication may be different outside and inside the biofilm.
2. PCR is a DNA amplification and detection test that is highly accurate. It is widely used.
3. The time duration between the last dose and swab tests seems sufficient.
4. The maximum antibiotic concentrations are achieved after starting the antibiotic. They peak and last for a few hours after administration. Antibiotics remain in the system for longer durations but not in the concentration required to destroy the microorganisms.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Raju A.T
Sorry one more question - just to clarify.
As the antibiotic cream would only stay in my system at a maximum concentration of 8-12 hours then getting the test done on Friday would be sufficient? This would mean being off the antibiotic Tuesday night, Wednesday, Thursday and Friday.
Would Saturday be preferable just to be safe or it wouldn't make much difference?
Just want to make sure the accuracy isn't compromised at all this time before I leave Spain!
Also do you know how long on average it would take to receive these kind of test results from the laboratory?
Thank you so much for all your help!
XXXXXXX
As the antibiotic cream would only stay in my system at a maximum concentration of 8-12 hours then getting the test done on Friday would be sufficient? This would mean being off the antibiotic Tuesday night, Wednesday, Thursday and Friday.
Would Saturday be preferable just to be safe or it wouldn't make much difference?
Just want to make sure the accuracy isn't compromised at all this time before I leave Spain!
Also do you know how long on average it would take to receive these kind of test results from the laboratory?
Thank you so much for all your help!
XXXXXXX
Brief Answer:
Maximum possible wait. Average 3 days for C/S reports.
Detailed Answer:
Hi,
Thank you for writing back.
1. Wait for the maximum time possible. There will always be residual drug in the body for a few days though it falls below therapeutic concentrations. This may affect the results.
2. On an average, culture and sensitivity results take 3 full days.
Wishing you a speedy recovery.
Regards.
Maximum possible wait. Average 3 days for C/S reports.
Detailed Answer:
Hi,
Thank you for writing back.
1. Wait for the maximum time possible. There will always be residual drug in the body for a few days though it falls below therapeutic concentrations. This may affect the results.
2. On an average, culture and sensitivity results take 3 full days.
Wishing you a speedy recovery.
Regards.
Above answer was peer-reviewed by :
Dr. Sonia Raina
Sorry to keep on asking you questions, but I am very worried about my condition!
I have stopped applying the Fucidin as you recommended, and organised an appointment to get a swab done on Friday morning.
I read on this page that it can be bad to stop Fucidin early? http://www.yyyyyyyyyyyyy.co.uk/yyyyyyyyyyyyyy/skin-and-hair/a7866/yyyyyyyyyyy-yyyyyyyyyyy-and-yyyyyyyyyy-y-acid/yyyyyyyyyyyy
The particular line I'm referring to reads:
"Unless your doctor tells you otherwise, it is important that you finish the prescribed course of this antibiotic medicine, even if it seems the infection has cleared up. Stopping the course early increases the chance that the infection will come back and that the bacteria will grow resistant to the antibiotic."
I know that you said it is safe to stop it early - would this advice not to stop it early just be a precaution?
My pain is worse today but that could be nothing to do with stopping the Fucidin (as I woke up in pain, the morning after stopping it). But I know it's really important to get this test re-done so there might be no choice.
Is there a difference between stopping a bacteriostatic antibiotic early and other types of antibiotics?
Should I re-start the Fucidin after getting the swab or simply wait for the results?
XXXXXXX
I have stopped applying the Fucidin as you recommended, and organised an appointment to get a swab done on Friday morning.
I read on this page that it can be bad to stop Fucidin early? http://www.yyyyyyyyyyyyy.co.uk/yyyyyyyyyyyyyy/skin-and-hair/a7866/yyyyyyyyyyy-yyyyyyyyyyy-and-yyyyyyyyyy-y-acid/yyyyyyyyyyyy
The particular line I'm referring to reads:
"Unless your doctor tells you otherwise, it is important that you finish the prescribed course of this antibiotic medicine, even if it seems the infection has cleared up. Stopping the course early increases the chance that the infection will come back and that the bacteria will grow resistant to the antibiotic."
I know that you said it is safe to stop it early - would this advice not to stop it early just be a precaution?
My pain is worse today but that could be nothing to do with stopping the Fucidin (as I woke up in pain, the morning after stopping it). But I know it's really important to get this test re-done so there might be no choice.
Is there a difference between stopping a bacteriostatic antibiotic early and other types of antibiotics?
Should I re-start the Fucidin after getting the swab or simply wait for the results?
XXXXXXX
Brief Answer:
There is no harm in stopping the Fucidin.
Detailed Answer:
Hi,
Thank you for writing back.
1. Most antibiotics in current use are bactericidal, which means they destroy the bacteria.
2, There is no harm in stopping the Fucidin ointment as it is a topical (local) application. this advice is for first time users or those with mild infections. You have already had multiple antibiotics, hence this is a different situation.
3. You may restart the Fucidin application after the swab. This will ensure some coverage while you wait for the reports. In addition, symptomatic relief of pain and inflammation is recommended.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
There is no harm in stopping the Fucidin.
Detailed Answer:
Hi,
Thank you for writing back.
1. Most antibiotics in current use are bactericidal, which means they destroy the bacteria.
2, There is no harm in stopping the Fucidin ointment as it is a topical (local) application. this advice is for first time users or those with mild infections. You have already had multiple antibiotics, hence this is a different situation.
3. You may restart the Fucidin application after the swab. This will ensure some coverage while you wait for the reports. In addition, symptomatic relief of pain and inflammation is recommended.
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much Dr. Bhatti, I really appreciate your assistance.
Brief Answer:
Thank You.
Detailed Answer:
Hi,
Thank you for writing back.
You can follow up with the reports here or directly at bit.ly/Dr-Sumit-Bhatti
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Thank You.
Detailed Answer:
Hi,
Thank you for writing back.
You can follow up with the reports here or directly at bit.ly/Dr-Sumit-Bhatti
I hope I have answered your query. If you have any follow up queries, I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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