Question: 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!

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?

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.

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!

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?

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?