Question: Hi,

I previously contacted you about a seemingly recurrent problem. You offered some great advice and asked me to follow-up, but my question was closed. I may have done that by mistake. I am going to provide the background relevant to my inquiry including the updates.

History: About 18 months ago, I had neck discomfort and an intermittent bad taste in my throat. The taste would last 10-20 seconds about once a day. I was placed on Augmentin 875 for three weeks for an undetermined possible throat infection and the issue resolved. 11 months later, a fistula developed over one of my upper molars. Around the same time the taste returned but it was not coming from the opening in my gums. It was in the back of my throat. It was discovered that I had an abscess due to a 15 year old failed root canal. I was told that a root was missed so the infection could have been simmering with no symptoms for a long time. The tooth was retreated, but the infection remained. A cracked root was then removed but the area did not heal properly so the tooth was removed. I was placed on a 7 days does of penicillin which resolved the bad taste temporarily. The taste returned about a week later so I went to my family doctor who prescribed another 3 week round of Augmentin 875 since it was successful 11 months prior. The taste almost immediately resolved and the neck strain got better but not completely. Within 3 weeks, the taste returned along with the neck pain. ALL of these symptoms are unilateral to my right side. I also get a pretty bad headache on the right side as the symptoms first begin to flare. I feel an odd sensation on the node directly below my ear between it and my jaw. It is a little inflamed. I get some occasional referred pain behind my ear and jaw.

Now with the latest. I saw a nurse practitioner who specializes in ENT issues who video scoped my throat. She said my vocal chords looks good and are moving well and she doesn't see anything there. She said part of my throat was a little red and asked about reflux. She suggested an x-ray of the sinuses. My ethmoid sinuses were completely full and my left maxillary sinus had some congestion, but nothing revealing anything specific to my right side was seen in that x-ray. I was not surprised by some of the congestion seen in the x-rays because I felt as if I had a cold or possibly some allergies after a camping trip and these symptoms were separate from my ongoing concern.

She placed me on a two week supply of clindamyacin 300 3x a day. We still do not know the source of the infection so this concerns me. She also prescribed prevacid for possible reflux, and nasonex.

Should I be concerned about taking another antibiotic without establishing the actual source of my problem? I know we are learning about the delicate microbial balance within the body including the nose and throat. Should I insist upon further testing before taking more medication?

Also, could there be a relationship between my tooth abscess and this infection? Could it have spread somewhere (ie. jawbone)?

Is it possible this infection became resistant to the penicillin based antibiotics?

I have not needed antibiotics in a couple of decades. I typically get colds or infections and they resolve themselves without a visit to the physician's office. This has me baffled. What kind of conditions could be contributing to a recurrent infection?

Thank you for your time and wisdom.
XXXX

Thank you so much for your guidance. To clarify, do you think I should give one last try with the clindamyacin for two weeks to see if that clears up the problem before taking the steps you advised? I know the clindamyacin would address any penicillin resistant bacteria if that is the problem. Or do you think I should NOT take the clindamyacin and get further testing before taking more medication.

I would like to add that I have no fever and my symptoms are uncomfortable but not severe.

Thanks, again.

XXXX

I just want to say thank you, Dr. XXXXXXX I very much appreciate your guidance. All the best to you.

XXXX