What are the treatment options for fungal infection caused due to blockage in sphenoid sinus?
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Hello, I am a 34 year old female (mother of a 3 year old). I have always battled with recurrent sinus infections and have tested positive to mold allergies. One year ago, I had a bad citrobacter ferundii infection in my sinus. I was given Doxycycline, Bactrim, and only 2 days of Levoquin- I couldn't tolerate the side effects and was put back on Bactrim. Found out I was allergic to Bactrim. My symtoms of sinus congestion improved and then I had a small sinus infection a few months later which resolved without antibiotics. About 3 months ago, a started feeling bad again and sinus congestion became worse. My ENT swabbed my nose and didn't grow any cultures. He prescribed Bactrim again, which I had an allergic reaction to on Day 8. He pulled me off and gave me Doxycycline for 10 more days. I still have congestion so I got a CT scan and another culture. The CT Scan shows major blockage in syphenoid sinus that looks like a fungal infection. It also shows chronic inflammation in my other sinus, a significant deviated symptom to the right, where I have all my problems. I also cultured positive for Citrobacter again! They ran sesitivities and Doxycline, Bactrim, Levoquin and Cipro were the best (Cipro being the best). I am scheduled for surgery in 2 weeks to open up my sinuses, flush junk out, and see what's going on in the syphenoid sinus, and to fix my deviates septum. My long winded question is should I start the Cipro now or wait until after surgery. I feel like if this infection has been going on a year and has been exposed to Doxycyline, Bactrim, and a little Levoquin twice now, it is probably pretty resilient. I have one shot with the Cipro and want to make it count. I was given a prescription of 14 days. What is your recommendation and what happens if I do take it now, have the surgery, and then it isn't cleared. What are my options? At that point it would have 13 days of Cipro and then 2 weeks off while I healed. Seems like that would be a hard case to treat. My ENT is now gone for 1 week over the holidays and need to make a decision about antibiotics today!
Posted Sat, 1 Feb 2014 in Ear, Nose and Throat Problems
Answered by Dr. Pavan Kumar Gupta 1 hour later
Brief answer.....given below Detailed answer.... Hello, Thanks for the query. In my opinion,you should get the surgery done to get your sinuses cleared and then take the antibiotic course. In blocked sinuses,the antibiotic wont have that much effect. Antibiotic would be do much better,once the block is removed and the nasal passage becomes open. Till then you can do steam inhalation,avoid cold drinks and drink more of hot soups and liquids. I hope it helps,however you may revert to me for any further query. Best of luck Thanks
Follow-up: What are the treatment options for fungal infection caused due to blockage in sphenoid sinus? 6 hours later
If I start the cipro now and it ends up being ineffective (but preventative for spreading), can I use it again after surgery with any hope of irradicating citrobacter? How will I know it's irradicated since last year there was a period I was not symptomatic? Finally, is it more likely that this is the same infection as last year or is it more likely a new one?
Answered by Dr. Pavan Kumar Gupta 20 minutes later
Hello, If you use CIPRO now,then chances are that it won't be effective after the surgery. Even if you dont use CIORO now,there is no risk of spreading any infection. In my opinion,you should get the surgery done and go for a repeat culture again and then start the antibiotic according to the report. Normally use of antibiotics for 3-4 weeks is sufficient to eradicate the infection,however you may get a repeat culture done to confirm it. It must be a new infection with the same organism ,since you remained asymptomatic for a very longtime after the first antibiotic course. Thanks
Follow-up: What are the treatment options for fungal infection caused due to blockage in sphenoid sinus? 2 hours later
Thank you. You have convinced me to wait until after surgery, however, the dr on call said to take it. I took one dose this evening. Is it ok to stop now and wait 2 weeks? Also, what are the risks of waiting and not treating the citrobacter now? If it was enough to show up on a culture I'm pretty infected. Can it spread? Can you explain why it would be less effective if I treated with Cipro both now and after surgery? Thank you again for all your time and expertise.
Answered by Dr. Pavan Kumar Gupta 3 hours later
Hello, There is no hard and fast protocol regarding the use of CIPRO. You may take the CIPRO as advised by your doctor,but make sure that the continuity of the dose is not broken.It is not proper for any antibiotic to be given for 2 weeks and then give a break for couple of days and then again take it for 2 weeks. Any break in continuity of any antibiotic can result in antibiotic resistance. Although any infection can spread but the chances are very very low for you since you are young,not immunocompromised and not having systemic diseases like diabetes and you are not having any history of spread of infection in past. Rest assured ,you are not going to land up with any problem. Best of luck for your surgery and hope you shall be all right after that. Thanks
Follow-up: What are the treatment options for fungal infection caused due to blockage in sphenoid sinus? 16 days later
Hi Dr XXXXXXX First, I tried to write an excellent review of you, but the site was down. I want you to know that I really appreciate and trust your advice. I have another question. I just completed sinus surgery on Monday 1/6. My ENT prescribed Cipro to treat the citrobacter and to prevent any infections from surgery. I am concerned (and tried to express this to him) that I don't need Cipro because I did not have any sinus symptoms 2 weeks before surgery. I think either the infection cleared on its own or the one dose of Cipro did it. I have no real understanding of disease to know if this is the case. He prescribed it to me anyway and I have no taken 500 mg 2x a day since Tuesday morning. So a total of 5 doses/pills. The ENT said I only need to take it for 5 days. His logic is that by opening the sinuses and cleaning them out, infection has no where to settle. I disagree. I have read that scabbing and crusting after surgery is common which leads to infection. Since this bacteria is so serious, would you recommend a longer course (10-14 days) of Cipro or should i take my chances with 5 days as the ENT recommends? Also, if I stop after 5 days and I get another citrobacter infection, will it be harder to treat with Cipro? Can it even be treated successfully with Cipro? He never cultured my sinuses again before surgery (when I was asymptomatic). Thank you again for your time!
Answered by Dr. Pavan Kumar Gupta 45 minutes later
Hello, I would like to go in little detail. The goal of endoscopic sinus surgery is to improve the drainage of the sinuses and prevent mucus from building up in these chambers. When secretions accumulate in a blocked off sinus, they may become infected with bacteria and result in a flare up of sinus symptoms. By widening the natural drainage of the sinuses, surgery helps to decrease the frequency, severity, and duration of infections. It is important to understand that surgery is not a cure for sinusitis. In most patients with sinusitis, the lining of the nose and sinuses,mucosa,overreacts to irritants, swells, and causes accumulation of mucus. Sinus surgery does not directly treat this over-reactive lining, but instead drains the sinuses and allows the mucosa to improve on its own. However, due to allergy or irritant stimulation, the lining may remain inflamed after surgery. It is on this inflamed mucosa that infection may take place. Since this inflammation doesn't become all right in 5-7 days and may take 2-3 weeks to go,the antibiotics should ideally be used for a long time like 2-4 weeks,depending upon the endoscopic finding during surgery. If i were your treating doctor,I would have preferred antibiotic course for at least 2 weeks. A far as repeat infection is considered,a culture at that time would reveal the identity of organism and about the antibiotic to be used. I have tried to write in very detail and hope you understand everything about it. However,I can not assume the role of your treating doctor and so it is left on you and your wisdom. Thanks
Follow-up: What are the treatment options for fungal infection caused due to blockage in sphenoid sinus? 24 hours later
Thank you for your follow up and explanation. I just wrote a long response and lost it so I will try again now. I have reached another predicament with the Cipro course. I am experiencing difficult side effects- muscle weakness, exhaustion, and nausea. The muscle weakness is a little concerning because I have heard it can be irreversible and can get worse- tendon rupture/ nueropathy. I spoke with my ENT and he said to get off the Cipro. He never cultured during surgery and suggests I come in for sinus debridement next Wed (1/15) and he will culture then. It takes 74 hours to grow and an additional couple days to learn sensitivities. I feel like this is a XXXXXXX move to get off antibiotics completely while I wait for a culture. That would involved a week long lapse in treatment. When I was originally cultured before surgery, citrobacter grew and the following sensitivites were listed: (Levoquin- which I had a bad reaction to a year ago, Cipro- highest sensitivity, Doxycycline- which I was taking at the time of culture so probably resistant, Bactrim- which I'm allergic to, and an IV antibiotic which is less sensitive than cipro). I feel that if I'm re-cultured and citrobacter grows, then I have limited treatment options. If there is citrobacter, the ENT says he would give me Levoquin in a nose spray so my body has less to process. Since Levoquin is in the same family as Cipro, would the citrobacter be less sensitive (since it's been exposed to cipro)? I am at a loss. Do I gamble on side effects of Cipro (which increase in severity and liklihood the longer I take it)? Do I get off the drugs and wait for a culture? Is it safe to be off all antibiotics while I wait for a culture? And finally, if I decide to stick out the Cipro, how long should I take it?
Answered by Dr. Pavan Kumar Gupta 17 minutes later
Hello, It would be better if CIPRO is stopped because it is very difficult to say whether serious muscle weakness or tendinitis or tendon rupture would set in or not. There is no need to take risk on that account. You may wait for the culture and in meantime,you can start with doxycycline. This way there would be some antibiotic cover and protection. Once report comes in suitable and proper changes in antibiotic may be done,if required. Thanks
Follow-up: What are the treatment options for fungal infection caused due to blockage in sphenoid sinus? 20 hours later
Hi Dr XXXXXXX My ENT does not want to prescribe Doxycycline (according to his nurse- I can't seem to ever talk to him directly). They want me to come in on Monday at 3:30 and get cultured again. Do you think it is safe to be off all antibiotics until I speak with them in a couple days? What are the risks?
Answered by Dr. Pavan Kumar Gupta 22 hours later
Hello, Not much risk,if you are not taking any antibiotic for couple of days. Get the culture done,as it will reveal the organism as well as the antibiotic. No problem,carry on. Best of luck Thanks