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Undergoing Treatment For A Staff Infection Of The Sinus. Prescribed Vancomycin. What Is The Best Course Of Action?

Posted on Wed, 5 Sep 2012

Question: My husband 59 is undergoing treatment for a staff infection of the sinus. Test results show the big is resistant most common antibiotics except Cubicin(daptomycin) Vancomycin and another high powered drug. He was on a combination of Cubicin and Invance (iv) for 2 weeks. Blood tests showed an increase in a liver enzyme and low neutrophil count. His Dr. Is now recommending Vancomycin and another antibiotic (iv) infusion 2x a day for a month.
An alternative is surgery. Im concerned that if this round of treatment is ineffective that a resistant infection may develop that is not responsive to anything.
My question is should we opt for surgery now and forgo the antibiotic treatment? Most likely he will need surgery anyway and post surgical antibiotic treatment possibility with the same drugs as above.
What is the best course of action at this point?
He has had the infection for over a year, is a diabetic, overweight, and hypertensive.

Answered by Dr. Rakesh Madhyastha (5 hours later)

Hello

Thanks for the query

This situation is what we are seeing in our everyday practice, multi resistant bacterial infections are on the rise. I will consider your husband lucky as there are some antibiotics which are still effective against the bacteria

I recommend he undergoes surgery as soon as possible following which he has to receive the course of vancomycin. Here in our set up we give the option of keeping the Iv cannula on and send them home, only to come to the hospital for the two doses of vancomycin.
Please don't avoid Iv medications more do because he is a diabetic and he has higher risk of it converting into a systemic Involvement especially meningitis and encephalitis since the sinuses are involved.
I hope I have answered your query, please get back to me if you have any further ones

I wish him a speedy recovery

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (1 hour later)

I'm sorry but I didn't quite understand if he should go on the two new antibiotics as well as have the surgery? I know he will be put on meds post surgery but should he continue with the recommened course now?

Answered by Dr. Rakesh Madhyastha (8 minutes later)

Hello

I am sorry if I was not clear

Yes, he should be on the two antibiotics and go for surgery. That is the best option for him. Vancomycin is safe in people with raised liver enzymes. Surgery only brings down the bacterial load but does not eliminate it completely so if will need surgery plus antibiotics to prevent recurrence

I hope I was of help

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (1 hour later)

Thank you for your response. I will tell my husband your recommendation. I appreciate your prompt reply. I believe you are correct with this approach. Now we will see what his Dr. Says tomorrow.

Answered by Dr. Rakesh Madhyastha (4 minutes later)

Hello

You are taking the right decision.

I am glad I was of help to you

I wish you husband good health and a speedy recovery

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar