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Suggest Treatment For Recurrent Sinus Infection And Cold

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Posted on Thu, 4 May 2017
Question: My girlfriend has been quite ill with a bacterial cold (her doctor already tested her for the presence of a viral infection and it proved to be negative) for the past three weeks. She was given a prescription for Amoxicillin (AKA Augmentin) 875 mg which she has been taking faithfully every twelve hours for the past five days, but her progress has been slight and very slow and she still is quite ill and a sinus infection that developed five days ago when I took her to her primary doctor (a GP and Internal medicine doctor) still is quite painful. (By the way, she is diabetic, and I know that high blood glucose compromises the immune system, but still....) I used to work in a hospital for nine years and I know a good bit more about these matters than most people, and I personally think that something like Aziththromycin should have been the med of choice--what do you think? I am going to take her back to her physician in about two hours and I am curious as to what possible change of medication (if any) that he will now prescribe. I remember that the last time that I had a serious bacterial cold about 5 years ago (I rarely ever take antibiotics--the same goes for my sick girlfriend) MY doctor prescribed Azithromycin and, within a few hours of taking the first (two) pills, I felt significantly better.

Isn't Amoxicillin (Augmentin) an unusual medication to be prescribed these days?

My girlfriend's sinus infection is still painful (it is on the left side of her heads) and was throbbing until a few days ago--but still painful--to the extent that she is chewing on the opposite side of her mouth.
doctor
Answered by Dr. Dr. Prasad J (1 hour later)
Brief Answer:
Antibiotic based on culture sensitivity....

Detailed Answer:
Hi,

I went through the details posted. Let me try to be specific here.

1. In general comparing Augmentin (Pencillin drug) and Azithromycin, the former has better bacterial coverage than azithromycin. Therefore in a bacterial infection when we are not sure of specific bacteria causing it, augmentin is a better choice than azithromycin.

2. However in some cases, bacteria infecting the sinus spaces could be resistant to penicillin, therefore it may not work. In that case, yes, we need to shift to another antibiotic.

3. That being said, if viral tests were negative, it doesn't prove what she has is indeed a bacterial infection unless a gram stain or a culture on sinus secretions are performed.

In this circumstance, my suggestion to your friend will be - 'Get back to the doctor for reexamination. I will strongly recommend performing test - nasal swab as well as culture and sensitivity test. The test will allow us determine specific bacteria and the sensitive antibiotic. The next course of medication will be based on the test results.'

In the meanwhile, I recommend pain medication, steam inhalation and antihistamine drugs.

Hope I am clear. Let me know if you need clarifications.

Regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dr. Prasad J (1 hour later)
Thank you for finally responding--one question remains: doesn't a gram stain or a culture on sinus secretions take days to get the results? If so, might her doctor (who she is going to see tomorrow morning) prescribe an antiviral drug (such as Tamiflu) to be taken in conjunction with the 850 mg Augmentin every 12 hours. just in case that she has both a bacterial as well as possibly a viral infection? Is it O. K. to take both at the same time? (Jayne has pain now and the only reason that it is bearable is because she happens to have some Vicodin pills left over from several years ago (but they still work fine) BUT she is running out and only has a few left. She has also been prescribed Tramadol for arthritic pain and has been taking TWO instead of one because of the sinus pain--if she was getting better she shouldn't have to take ANY of those pain medications (excpt for the one Tramadol several times a day).
doctor
Answered by Dr. Dr. Prasad J (44 minutes later)
Brief Answer:
Gram stain / nasal swab results should be available in a day.

Detailed Answer:
Though culture will take 3 days for results, nasal swab gram stain results will be available in less than a day.

If her symptoms are consistent of viral flu I don't see any problem to start antiviral tamilflu along with antibiotics. A good clinical examination is very important. Plus it's also important to take samples for aforementioned tests before starting these drugs. So I insist to get back to her doctor. Don't self medicate from left over drugs.

Lastly pain medications are as and when necessary. But if pain is consistent we may start round the clock antiinflammatories like ibuprofen. They have additional benefits in treating inflammatory changes along with pain relief.

I hope you got my point. Feel free to ask questions before closing discussion.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dr. Prasad J (22 minutes later)
You mentioned ibuprofen as an anti inflammatory, however, XXXXXXX had once had partial kidney failure two years ago (when she wasn't controlling her blood sugar properly--as I mentioned previously, from which she almost completely recovered after two weeks in the hospital). XXXXXXX is an insulin dependent diabetic and she was told by her nephrologist that she cannot take aspirin, ibuprofen or naproxen sodium because they stress her kidneys. What anti inflammatory can she take--either over-the-counter or by prescription? All that she has been told that she can take for pain is Tylenol, which has no anti inflammatory properties. (Jayne has been prescribed the other pain meds that I mentioned--even the Vicodin (from an old prescription from ten years ago), which she is almost out of.
doctor
Answered by Dr. Dr. Prasad J (18 hours later)
Brief Answer:
Antiinflammatory drugs to be avoided...

Detailed Answer:
Apologies for the late reply. I had a busy schedule which could not be avoided.

Can you elaborate bout her kidney failure? Was it induced by acute kidney disease or chronic kidney disease? If she has chronic kidney disease, yes antiinflammatory drugs should be avoided. Instead opioid drugs either tramadol or vicodin can be used. These are not available over the counter though.

Discuss with her treating doctor and plan her treatment at the earliest.

Hope this helps.

Regards
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

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

General & Family Physician

Practicing since :2005

Answered : 3708 Questions

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Suggest Treatment For Recurrent Sinus Infection And Cold

Brief Answer: Antibiotic based on culture sensitivity.... Detailed Answer: Hi, I went through the details posted. Let me try to be specific here. 1. In general comparing Augmentin (Pencillin drug) and Azithromycin, the former has better bacterial coverage than azithromycin. Therefore in a bacterial infection when we are not sure of specific bacteria causing it, augmentin is a better choice than azithromycin. 2. However in some cases, bacteria infecting the sinus spaces could be resistant to penicillin, therefore it may not work. In that case, yes, we need to shift to another antibiotic. 3. That being said, if viral tests were negative, it doesn't prove what she has is indeed a bacterial infection unless a gram stain or a culture on sinus secretions are performed. In this circumstance, my suggestion to your friend will be - 'Get back to the doctor for reexamination. I will strongly recommend performing test - nasal swab as well as culture and sensitivity test. The test will allow us determine specific bacteria and the sensitive antibiotic. The next course of medication will be based on the test results.' In the meanwhile, I recommend pain medication, steam inhalation and antihistamine drugs. Hope I am clear. Let me know if you need clarifications. Regards