question-icon

Suggest treatment for recurrent sinus infection

default
Posted on Tue, 16 May 2017
Question: Hello!

I have suffered from recurrent sinus infections and issues. I have treated with several different antibiotics and have had 2 sinus surgeries (one FES and one balloon sinuplasty) with reduction of my turbinates and septoplasty twice. I have cultured for citrobacter ferundii for 4 consecutive years at 3 different ENT offices and living at several different homes. So it's unlikely a re-infection. I seem to only culture for the citrobacter when I'm symptomatic. I am growing extremely frustrated with the inability to eradicate this bacteria. I would greatly appreicate any of your insight!

1) Is it possible to completely eradicate this bacteria? If so, how? (I've treated both systemically and topically with the antibiotic it is sensitive to- doxycycline, bactrim (which I discovered an allergy to, and Cipro which I have trouble tolerating and could never finish that course. Cipro was used in my last surgery to flush out the sinus cavities).

2) Is it dangerous to leave untreated.There are many times since I've had it (or known that I've had it) that I'm asymptomatic. My fear is that one day I may be immue-compromised or elderly and then I won't be able to get a handle on the opportunistic citrobacter or it could spread.

3) Why does my cultures sometimes return clear and sometimes with citrobacter. It usually cultures when I'm symptomatic.

4) where is the infection hiding? Can a systemic antibiotic or topical spray reach the bacteria? Never tried antibiotics when not congested. Could that work?

I have a deep respect for doctors and want you to know that I truly appreciate what you are doing for humanity. Thank you!
doctor
Answered by Dr. Priyanka Aggarwal (3 hours later)
Brief Answer:
Repeated infection

Detailed Answer:
Hi
Welcome to HealthcareMagic and thanks for putting up the query
Any infection if comes on culture sensitivity should be treated. Yes citrobacter can be eradicated completely. Get a culture repeated once antibiotic disr is completed and if it is still positive than continue with antibiotics. If oral antibiotics are not working go for injectable and higher antibiotics. Send me your reports, it will be easier for me to suggest you better.
The infection might be resting in a source like an infected tonsil or some other cause like sinusitis. You should get yourself examined by an ENT SPECIALIST.
Nasal spray can't treat infection but only helps symptomatic.
Any further questions are always welcome.
Wishing you a speedy recovery.
Thanks and regards
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
default
Follow up: Dr. Priyanka Aggarwal (38 hours later)
I have the sensitivity lab report uploaded to this site. It was an old culture (before my first surgery)but I assume it would be the same since its the same bacteria on the latest culture. I have been treated exclusively by an ENT Specialist and the topical spray is a mixture of an antibiotic, fungicide, and antihistamine.

I have received several cultures over the years of my sinus troubles but only about half the time does citrobacter appear on the report. Why is that?

Finally, I have treated with sensitive systemic antibiotics before without success. What would you recommend now? A longer course? If I continue to treat with a longer course and then the bacteria cultures out again, where does that leave me? Will the bacteria become resistant?
doctor
Answered by Dr. Priyanka Aggarwal (45 hours later)
Brief Answer:
Repeated infection

Detailed Answer:
Hi
Thanks for the follow up query.
Citrobacter usually persists in urinary tract infection. if the infection persists or recurrence is there time and again you should get a urine and blood culture sensitivity done. The reason for infection can be immune deficiency. You should consult an immunologist also.
The effective antibiotic might need to be continued for longer duration ar multiple antibiotics might be required.
Any further questions are always welcome.
Thanks and regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
Answered by
Dr.
Dr. Priyanka Aggarwal

ENT Specialist

Practicing since :2008

Answered : 1394 Questions

premium_optimized

The User accepted the expert's answer

Share on
Suggest treatment for recurrent sinus infection

Brief Answer: Repeated infection Detailed Answer: Hi Welcome to HealthcareMagic and thanks for putting up the query Any infection if comes on culture sensitivity should be treated. Yes citrobacter can be eradicated completely. Get a culture repeated once antibiotic disr is completed and if it is still positive than continue with antibiotics. If oral antibiotics are not working go for injectable and higher antibiotics. Send me your reports, it will be easier for me to suggest you better. The infection might be resting in a source like an infected tonsil or some other cause like sinusitis. You should get yourself examined by an ENT SPECIALIST. Nasal spray can't treat infection but only helps symptomatic. Any further questions are always welcome. Wishing you a speedy recovery. Thanks and regards