As a medical narrative, this story is weak. The timeline is vague, so I necessarily have to guess at the course of events: international travel followed some weeks later by great fatigue, cough, headache, and the other symptoms, as described. Then a course of three antibiotics over approximately three weeks. Then the final diagnosis is "sulfa reaction"?!
That explains only the latter part of the story, but leaves everything leading up to it without an explanation or resolution.
I find this article frustratingly incomplete.
328
Travel/exhaustion/college student/a few probable viral infections and most likely congestion and sinusitis due to allergies.
Then a sulfa drug and the bad allergic reaction to them is higher in the female population. All clear to me; but the frustration of the timeline and medical path to recovery is that sinusitis is often a overly diagnosed and then the start of overly used antibiotics and steroids and then perhaps surgically intervention a septoplasty surgery.
Again, the younger dedicated infectious disease doctor (often a new immigrant or first born immigrant from India or Britain, saves the day)- something I’ve noticed in several Dr Sander’s articles and I always choose one if I have a choice. Thank you dedicated professional immigrants for your smarts and application to your specialty and skill set of not forgetting to look and touch and listen to a patient and their body,
65
@Javman At the end they say the congestion/headache was probably allergies or back-to-back viruses, which eventually cleared up by themselves a few weeks after her hospital visit. The severe illness was a drug reaction, the other stuff leading up to it of a less serious nature.
2
@Javman agreed. I worry that this young woman may have years of relapses and unexplained symptoms ahead of her.
4
While cleaning up my papers I found this article from February 2. In retrospect it appears so obvious that she was suffering from COVID-19, but at that time it was still a mystery virus. Interesting to read that she felt she had picked it up while traveling in Europe & Asia three months previously.
1
Initially, in retrospect, Covid-19, no? She’d been traveling in Asia and Europe. I wonder if the patient has since been tested for antibodies.
2
The original protocol for PRESCRIBING antibiotics was to also have the patient ingest yogurt on a prescribed schedule . Why? to replenish the GI microbiome destroyed by the antibiotics.
I have yet to consult a dr. who knows this, or is willing to practice it . There is something seriously wrong with medicine practice in the US. We each have to become our own doctors.
4
Time to write about 21st century medical conditions and treatments. Same with Jane Brody's column.
This patient was evidently given 2 different antibiotics for a 'supposed bacterial' infection or pneumonia. No mention if the bacteria, if that's what it was and not viral or fungal, was tested in a lab to determine the strain and then cultured to see what if any antibiotic was sensitive to it. Were either or both antibiotic resistant? This isn't determined by the fact that they didn't work.
If fact, giving an antibiotic depresses the patient's immune system, and if given totally inappropriately -- because that's "what we do" when a sick person presents -- the patient can become sicker, even see her life threatened.
So, please NY Times, write a headline story about what can happen when antibiotics are given these 21st century days and make the patient sicker. Not to mention that they kill healthy cells too, leaving the patient's own immune system depressed for up to two years. Please describe biofilms that can form as a protective shell around infectious cells that appear dormant until another antibiotic enters the fight.
1
what confuses is me, is the fact that she had all of the symptoms except the rash before she took the Bactrim. The headaches, the weakness, the back pain. You can't blame that on a sinus infection or a drug reaction, especially if the symptoms were there first. I still say it is a mystery. That being said, we are often too quick to prescribe antibiotics. They all have potential for serious side affects.
1
Doctors have to stop giving out antibiotics like they were candy.
7
I was given Bactrim for an upper respiratory infection almost 15 years ago. It caused me a lot of severe GI complications (including liver), because of which I am still suffering and will need additional medications for the rest of my llife. Many doctors consider sulpha drugs to be benign and prescribe it as a first level of defense since it is a fairly broad spectrum antibitbiotic and is inexpensive. Sometimes it is also prescribed in very high doses for MAC infections. Anyone considering this drug should be informed repeatedly of the potential disastrous long term side effects.
7
To be sure, antibiotics should be avoided and perhaps were inappropriate in this case. But the head congesting symptoms of "sinusitis"----loss of hearing, a stuffed head, and fatigue even after a good night sleep--- have been my life for many years during times when allergies are "only" moderately high. This "small nuisance" is tough enough to live with for months---without wrong diagnosis and treatment----which does not seem to exist. Like many allergies, it is very debilitating for active living.
In my case and I suspect in others, Eustachian Tube Dysfunction (ETD) complicates the situation. The usual ENT Rx of topical nasal sprays do not seem to help much, nor does Neil Med Nasal Rinsing.
It would be nice if Dr Sanders would look for other situations where sinusitis and ETD has been corrected.
I disagree that this article was "inappropriate" for "Diagnosis."
Thank you Dr Sanders.
3
All drugs come with possible side effects. Some are worse than others. I have also had the Bactrim rash and it was somewhat unpleasant to say the least. What I find so troubling in this case is that no one tried to find out what was actually wrong with this young woman before prescribing some very powerful and potentially nasty drugs. I have the impression that no one ordered any testing until she landed in the emergency room. Antibiotics have saved countless millions of lives but they have also killed people who are allergic to them. And their overuse has allowed "super bacterias" to proliferate. It seems to me that doctors ought to be sure they are needed before prescribing them.
8
I had the persistent headache, non-stop sore throat, nasal congestion and fatigue just like this woman. When I asked my doctor for painkillers for the headache, he paused, then asked whether I had allergies. I think so, I replied. He prescribed daily loratine tablets and twice daily flixonase nasal spray. He made an appointment to review my symptoms after a month of this treatment, and I was happy to report that all the symptoms, including the headache, were gone and I felt fine.
5
Her symptoms without any objective evidence of disease sounds psychosomatic to me.
@A Quinn There are hundreds of objective signs of illness that have yet to be discovered or even fathomed by medicine. The history of medicine is to blame anything that current available medical technology can't discern on the patient (psychosomatic, malingering, conversion disorder, etc). MS was called the fakers disease not too long ago. MRI's were not available until the 80's. Small Fiber Neuropathy didn't exist supposedly until it was discovered with an improvement in biopsy capability. Ulcers were psychosomatic until the bacterial cause was finally begrudgingly accepted. Blaming the patient for the shortcomings in medical technology/knowledge is a constant in medical history, and the height of arrogance in medicine.
24
I’m no doctor but I picked up the Bactrim reaction immediately. Personal experience, only absent steroids I saw the rash, stopped the drug and told my doctor who then confirmed the allergy. He also said it was common, and to avoid sulfa drugs going forward. Am I missing something or was it kind of nuts for this patient to be prescribed a sulfa drug, steroid cocktail in the first place?
8
Jake Wardwell, DO,
The patient got better without diflucan (fluconazole); additionally, had she a fungal infection in her sinuses, she would also probably have presented with a fungal meningitis; that did not happen, thanks to God.
Fluconazole, (diflucan) is a very serious drug when given longterm, although it is a very useful drug when absolutely needed, but she did not need this drug especially when she had such a serious reaction to Septra(bactrum).
5
my question is: what were the other antibiotics she took before the Bactrim. Fluoroquinolones (Cipro, Levafloxin, etc. ) cause this kind of damage but worse and often permanent disability for hundreds of thousand of people. I was bed ridden for two years after 10 days of Levaquin, and I ruptured a tendon after Cipro.
9
@Deborah Silver Goodman
I also had fluoroquinolone-associated tendinopathy of my Achilles’ tendons. Fortunately I avoided Achilles’ tendon rupture.
2
What is wrong with our medical system. The initial doctors probably were on a tight schedule so they just did the quickest thing An Rx for antibiotics, instead of taking time to culture and see if it even is a bacterial infection or a viral one which is not susceptible to antibiotics. And for the ENT to casually again prescribe even more antibiotics even after her horrible reaction to them is callous and incompetent.
I’m glad she got better on her own. Probably rest and fluids did the trick, a remedy she should have advised on the beginning. I hate to think of the huge costs of all that hospitalization and ER visits
11
I'd love to know the costs involved in what this young woman experienced.
8
Bilharzia!?
1
What about an undiagnosed parasite infection?
1
But the patient had all kinds of symptoms, (except for the rash) before she took the Bactrim!
She was ill with fatigue, myalgias, pharyngitis, cough and congestion on the day she couldn't walk across campus.
This wasn't just a Bactrim-rash.
What about her sx at the onset?
20
@Betsy
I am also puzzled by this article. The ID specialist correctly diagnosed a rash from Bactrim, but that’s a common side effect. What about her weakness, her throbbing shoulders, her sore back? We aren’t told the time course of those symptoms relative to her antibiotics and they aren’t typical side-effects of antibiotics.
14
@Betsy
I had very similar symptoms - cough, clogged sinuses, fatigue - for months! Treatment with a succession of three different antibiotics and the dospac with little or no relief. Claritan did help. It finally cleared up but with no cause ever discovered. I was hoping that the article would solve the underlying medical problem and was most disappointed that it was never really addressed.
3
Me too. Turns out it was allergies, and cleared with antihistamine treatment.
Similar thing happened to me. Was prescribed prednisone for sinusitis. Made me feel worse with migraines and vomiting. My blood work came back messed up. Was prescribed more prednisone. Was hospitalized and my body was shutting down. After three days a doctor asked me what I did different- I said first time on prednisone. Stopped taking it within five days was back to normal. And the sinusitis was actually allergies. Beware of side effects of medicine.
15
it goes to show you how important second and even third opinions are in the medical field. It reminds me of a story I heard of a man who had elevated numbers on a blood test, the elevated numbers worried the doctor treating him, who thought he had a form of cancer the patient of course panicked and was full of anxiety, fortunately the man was Howard Stern who had access to the finest doctors in the world , he was able to talk to the lead cancer doctor in the world, who solved the problem in a one minute phone call. The doctor listened to sterns symptoms and the key numbers from his blood test, then he asked Stern a question not one of the other doctors had asked : “ are you eating a lot of fish ?” Stern told him he had just changed his diet to all fish . “ Thats the problem, the fish is elevating all those levels , cut down on the fish.” When it comes to medical problems being lucky in the doctors who treat you makes all the difference in the world,
16
@Lonnie Makes no sense at all. What "elevated numbers on a blood test" are due to eating fish and are suggestive of cancer?
2
@SF Google it. Related to high mercury levels from eating high amounts of fish.
3
Scombroid fish poisoning?
Great case. Systemic allergies are really awful to feel and a bit scary to think about.
I'm struck here by how many physicians were involved, and how little time each seemed to have for the case. The converse, of course, is that this woman showed a lot of strength in continuing to seek care.
Most of the time the answer *is* antibiotics. So diagnosticians can guess right with limited info most of the time. I wonder how much of antibiotic over-prescribing is attributable to multiple providers with short sessions.
12
Patients should be encouraged to seek out alternative medicine in these instances where the traditional western medical techniques don’t work. It sounds like her immune system had been completely shot by the toxic medicine and the sickness only make it harder for her to get better. Natural herbs and supplements could be so beneficial to build back up her immunity! Wish the medical industry tended to prioritize the patient and their BEST need, not just the standard procedure. It’s coming to a breaking point — time for change and new structure to the failing system.
1
@Bre B.
Herbs and supplements also cause allergic and yes, even toxic reactions!!! Often, no one knows they are involved because they aren't considered medicine and the person presenting to the doctor does not provide the necessary information.
I agree with you medicine needs to prioritize the patient. Sadly, now medicine, by and large, is no longer run by doctors but by administrators (who have never been doctors) who expect the doctor to see a minimum number of patients a day. Generally this means no time to really talk to the patient and get an adequate history because the doctor may be fired or get a reduction in salary if they do not see enough patients. Thus, a constant conflict between taking the needed time to be the medical detective that good diagnosing requires v seeing the number of patients needed per administration .
Another factor in this is the number of waiting patients who get angry if the Dr. is delayed by taking the extra time to figure out what's going on with the several patients with atypical problems.
1
Caught Histoplasmosis in Cincinnati in 1954. No drugs then.
I was diagnosed again in 2010 since it hides in bone marrow waiting for an opportunity. Been treating it for too many years now.
Antifungal, same one sprayed on fruit when it’s picked- itraconazole.
5
Lawrence, histoplasmosis is often contracted in warm, tropical climates, doesn’t sound like waters off Connecticut.
@JRS
Ooops, I meant to type Cincinnati but my iPhone has a mind of its own and proof reading is not always my forte.
1
This sounds fungal. Mayo Clinic did a study showing a high degree of positive sinus cultures for fungus in patients with “chronic sinusitis”.
The treatment isn’t always as easy as taking 6 weeks of fluconazole, though that can usually help. There are other parts of the regimen that sometimes are necessary that include dietary restriction of sugars and supplements that work synergistically with the medicine, like Saccharomyces Boulaardii and Gymnema Sylvestra. A sinus culture may confirm this but in most cases if other symptoms fit, fungal type skin rashs, dandruff, digestive symptoms then I usually treat empirically.
14
If fungal the problem is how to treat. If fungus confined to respiratory system old line antifungals may be best. Of course all antifungals have serious possible side effects. But at any rate antibiotics may pose more problems. Best to watch and wait.
2
Why didn’t any of these doctors try culturing for infectious bacteria before prescribing antibiotics? All doctors take at least one microbiology course in medical school. They should know that treating with antibiotics only works if the patient has an infection caused by a microbe that is sensitive to that antibiotic. The doctors were not practicing evidence-based medicine, as they had no evidence for a bacterial infection when prescribing antibiotics.
26
@DRN
retired AMA attorney F/71
We may show our age when we talk about "culturing" for anything before prescribing?
Remember these two facts: (1) The typical primary care physician in this country has eight minutes to get in and out of each patient visit in his or her office setting. (2) Unless there is a rapid point-of-care test + that physician's office has the required regulatory documents to use such tests, as with flu tests that can now distinguish types A and B, obvious symptoms and cursory history taking is all docs have to work with in their decision making.
An ER can consume more time for patients, but doesn't necessarily mean that there is going to be continuous assessment by one professional, usually a BSN/RN or NP/PA, before a decision maker arrives and starts sorting thru the maybe diagnoses with and without more tests or imaging done.
New Haven CT where this young woman was going to school may be one of the most potent examples in this country of the worst decay and chronic disease across its poverty blocks and the best resources for those around the Yale campus. Mix that full spectrum of humans in one doc's office or one hospital's ER and it's an invitation to bedlam for all.
10
@DRN
It’s hard to get a good culture in sinusitis. Often there isn’t any purulent material in the nasal cavity, and even if there is it often is contaminated with normal nasal bacteria. If you really need a diagnosis, say for a sick patient on the ICU, a big needle is punched through the thin cheek bone right into the sinus. But most patients in a clinic would not want that done!
There are clinical signs of infection, but they can be similar for both viral and bacterial sinusitis. Doctors generally would prefer not to give antibiotics for most ear and sinus infections since they usually are viral, but patients often push hard for an antibiotic.
5
@n.c.fl 'The typical primary care physician in this country has eight minutes to get in and out of each patient visit in his or her office setting" in order to make his financial target. There, fixed it.
8 minutes isn't some law of physics.
1
I had such a violent allergic reaction to Bactrim that I would up in the ER.
12
@BuffCrone I had had Bactrim without problem once or twice in my life before it was prescribed in October 2016 -- and had an awful reaction. Over a period of days I developed severe peripheral neuropathy over much of my body - numbness and pins and needles all over, difficulty swallowing (I lost 40 pounds in 3 months) and a chronic cough due to a sensation of something caught in my throat. Had CT/MRI scans and my throat scoped. Nothing. My neurologist concluded, as had I, that it was the Bactrim -- I was taking nothing else. The good news was that because it was apparently drug-based I might, maybe, recover somewhat but that whatever remained after a couple of years would likely be permanent. I have regained about 90% of the function in my hands but that's about it. I still get the occasional zaps of electric pain at random times and in random places, and have mobility issues because, frankly, I cannot feel my feet. I have walked out of my shoes without realizing it. I need to grip handrails going up and down stairs. I use a wheelchair at the airport. For someone who doesn't drive and was used to walking miles a day in all sorts of weather this is very discouraging. I keep on keeping on, using OTC pain killers and once a day (usually) gabapentin. I am now gunshy of starting any medicine for anything. But I remind myself there are millions of folks much worse off than I am all over the world.
4
This is simply silly. “ I won’t take antibiotics because the several prescribed did not work.” First of all, it is not unusual to have to take many different kinds. Second of all, ANTIBIOTICS save LIVES. Big whoop that you got better on your own. MANY folks need to continue to work with their practitioner to get better ruling out what it may be to what it IS. Refusing treatment (which has not harmed you) is just...silly.
13
Antibiotics destroyed my health. They always make me sicker. So now if I get sick, I just stick it out. Bronchitis will finally go away after about 6 weeks. But the side effects from the antibiotics last months and months.
10
@Mac Unless you've been through the medical mill- it's best to avoid criticizing. Scratch that. Why criticize the patient? Who is responsible for the care of her body?
4
@Mac It's not silly to refuse treatments that make you worse. I've had severe reactions and permanent damage from antibiotics that were prescribed when I didn't need them either most likely. They are valuable when prescribed at the right time for the right person. but not always.
4
Sulfa drugs are known to cause allergic reactions, I am surprised no medical personnel caught it sooner.
12
I'd suggest to the woman highlighted in the story, as well as anyone else who has drug allergies, to wear a medical alert bracelet mentioning this.
28
Because accompanying medical information with my prescriptions is not supplied in English, I research everything on the net.
Who would have thought a common painkiller was deadly to people of Irish descent?
I had to direct the pharmacist to the WebMd site where I found this info in order to get a different pill.
Another time, imagine my shock to wake up to learn I had an antibiotic drip of Cipro! I managed to unplug myself. Then waited a year to see if I had any of its possible life-time chronic side-effects. Of course I wrote the head of the hospital and complained. The EU was considering controlling or forbidding its use here.
9
@Alice
Which painkiller?
4
@Alice I also had a drip of Cipro and then 10 days of 500 mg of Levaquin. Was in bed for two years and still not the same. I weas on a cruise ship and was not given any warnings(5 of them frrom the FDA), nothing. Just woke up overnite unable to get out of bed. It destroyed my tendons, my gut, my brain, my teeth, my vision. Fluoroquinolone Toxicity. The US is still perscribing these like candy enven though the FDA has said not to.
6
@Alice
What common painkiller is deadly specifically to those of Irish descent?
There was a paragraph at the end of these articles asking for mystery diseases to be submitted, but NO unsolved cases, and that same demand accompanies this one.
I have no clue what is causing her initial symptom group, and that question is NOT answered, anywhere. And to say the rash, of which much is made, was due to a drug allergy is also specious, as is it is unproven. Clearly this is no Stevens-Johnson syndrome.
We don't have the complete blood work and serology, and in cases of mono, I have had to, in one instance at the insistence of parents, test again in three weeks to just assure them that the diagnosis made on exam and history was correct.
This week's column seems like a cop-out, and something that every writer with a schedule (worse for cartoonists) has eventually given in to, which is submitting something that is beneath their usual standards, and in this case against the submission rule of 'a solved case."
But then again, I have seen plenty of very sick people, with no explanatory diagnosis who have gotten better on their own, with careful monitoring and an immediate call in number if they were to become worse, and I guess that is the way it will be until we are all issued Star Trek Tricorders.
27
@reid I agree. She was very sick before she started taking the Bactrim and then got worse. What I ask caused her first illness ? At the end of the article there is no definite reason for her initial sickness but just a couple of maybes.
6
Think you can diagnose my illness? I've been to 8 doctors in five years, with no progress at all, just keep getting sicker. I'm curious now to see the autopsy, if they bother to do one. It just might be too expensive for my family.
2
I have the exact same allergy to Bactrim.
5
At this point, the only reason I go to a doctor is to get a prescription that I can't easily fill on the streets. Otherwise, I type in some symptoms and pretty soon, Harvard doctors are telling me in great detail on YouTube what is wrong with me. Marianne Williamson type gurus then give me a great list of natural ways to deal with it.
Doctors today remind me of an old meth dealer I once had. He wanted me functionally well enough to keep working so I could keep bringing him more money. But he sure was bummed when I quit and no longer needed his services.
One day, a doctor said to me "I wish I saw you more often" because he only hears from me twice a year for blood work to monitor my meds. So, I asked him out on a date in front of his nurse.
There will never be a cure for cancer because that would wipe out the oncology industry in this country. Our doctors want us sick enough to keep working for Bezos but not healthy enough that we don't need them. They are little more than drug dealers.
6
@tom harrison
| Otherwise, I type in some symptoms and pretty soon, Harvard doctors are telling me in great detail on YouTube what is wrong with me.
You should increase your life insurance policy.
1
@tom harrison
As a doc myself, I have a hard time buying in to "docs want you just sick enough" idea. We're all so busy, we don't need partially well patients to keep the exam rooms filled. My paranoid ideation runs more to "The Man keeps us so busy with stupid paperwork and electronic medical records that we have no energy left to fight an ineffective system. Somebody is making money off this." I wonder about the tools we have to work with that are developed by other people/corporations--pharmaceuticals, in other words. I would say your suspicions are likely correct for that branch of the medical-industrial complex. Read Margaret Atwood's fictional Oryx and Crake if you want to get really freaked out about this, or An American Epidemic about psych meds.
4
There will never be a cure for cancer? Respectfully, that’s baloney. My mother was cured of lung cancer in 2008-2009 at M.D. Anderson in Houston, and my older brother was cured of nasopharyngeal cancer in the late 1970s at an Air Force hospital in San Antonio. Both cured of cancer using conventional American medicine. Both cancer-free today. Maybe you mean to say there will never be an easy cure for cancer, but people get cured of cancer all the time.
6
Could also be fungal. Many fungi can involve the lungs. Overall too little analyses before pushing antibiotics. Remember “FIRST DO NO HARM”
11
No CT Scan, no extended sputum tests, no pulmonologist, no IgE blood tests? The woman could possible have a superbug that is now dormant, but will come back. For her continued health some facility should further test her and provide a real diagnosis.
14
Rebecca, the patient had a MRI, doesn’t seem that she would also need an additional CAT scan.
And the fight rages on amongst us! Pro or anti physicians, we continue to suffer accidents, illnesses, and diseases. I feel badly for this young person. No -medicine, pharma, and hospitals did not shine in this article but think of all the cases reported with a fortuitous result. Please think of those in Seattle/Ballard whose ER just closed near them.
3
I had bouts of sinus and developed bronchial asthma which started in childhood, and grew worse as I aged. In my late 60s I learned about biological dentistry and had all my mercury amalgams removed. The chronic bronchitis disappeared but I was still plagued with with sinusitis and extremely swollen turbinates. My dentist discovered that a prior root canal had been filled with mercury. She pulled that tooth, and all previous respiratory issues are gone.
Now over 70, my health has improved and my philosophy is that you can't poison your way to good health with phamaceuticals, food that isn't food, vaccines, and all the other dangerous substances we put in and on our bodies.
7
@P.O.
Don’t throw the baby out with the bathwater, vaccines save millions of lives, vaccines are incredible, and safe.
4
I thought one can be tested for evidence of a bacterial infection before prescribing an antibiotic. What about all the warnings to not take antibiotics for viruses and such?
9
@ArtOuzel Many, if not most patients who go to the doctor with a "sinus infection" want antibiotics, even when they are told it is probably a virus. And they certainly don't want blood tests and cultures, for which they may have to wait a few days and pay quite a bit extra, before they are given an antibiotic. They will just go to the nearest doc-in-the-box and get what they want
@SF Going to the doctor is not shopping on Amazon. Just because people "want" antibiotics does not mean they should be prescribed.
2
I took one dose of prescribed Ciprofloxacin and had an immediate reaction - rash on my legs. Called my doctor, she said come in right away, to not take another dose, she checked me out and confirmed that it was most definitely a drug reaction. I now have that drug allergy listed in all my medical records.
16
@Kathrine
retired AMA attorney F/71
Then there is the psych reactions with clindomycin! That tops my meds allergies list.
Fortunately, after ruinous GI adverse events with most antibiotics prescribed instead of finding the cause of chronic sinusitis (allergies), I can take and get excellent results with Levaquin. Ditto for Cipro.
Last 30 years infinitely better than the first thirty years knowing I'm off-the-charts allergic to house dust mites along with 27% of the U.S. population and a couple of molds. Change the diet to avoid the molds. Change my home to the delight of those who got my oriental area rugs and Amish quilts.
reme halo in my whole house air handler scrubs out all the remaining allergens with Filtrete 1500 air filters. White vinegar + baking soda mix learned from a grandmother is used to clean everything and avoid strong scents like bleach and washer/dryer sheets.
Hotels with allergen free rooms when I travel are long overdue and provide effective allergen control measures.
9
@n.c.fl Cipro and Levaquin have destroyed hundreds of thousands bodies and lives, and have caused death in thousands. This class of antibiotics as you know have 5 Black label warnings on them. You are fortunate. I was bed ridden for two yerars and had a ruptured tendon at a different time from these drugs. And I am one of many. Its an epidemic. These are untargeted chemotherapy drugs developed in the 1990s to combat penicillin resistance. They work for many, and I took Cipro several times before and had not had an issue. The Levaquin is by far the most dangerous and attacks all the soft tissue in your body, thats just about everywhere. Im on month 29 post poisoning. Itsd a lifechanger.
1
1. Did they ever do the spinal tap? Results?
2. Where did she actually travel? Anywhere disease endemic?
3. Could the ENT have cultured and identified the bacteria causing her sinusitis?
4. She took the Bactrim for 10 days. Despite the allergic reaction, could it have helped to some extent? Might she have benefited by a shorter disease duration if she took the ENT’s second prescription?
5. How do physicians read/critique her care?
6. Could she have had multiple diseases at once and/or sequentially from various causes: bacteria, virus, allergy, stress, foreign elements, mold, etc.?
7. Photophobia disproved? But, could have existed earlier due to encephalopathy/meningitis? Earlier spinal symptoms seem to have indicated as such? Relics?
8. Very glad that her immune system succeeded in that she eventually fully recovered. If this case happened a year or more ago, how has she fared since?
15
Thanks for giving my patients more reasons to distrust my medical opinions. Common things are common. There is no inappropriate care in treating her symptoms with common antibiotics. The "genius" doctor that saved her only was clued into the new problem by the rash which was not present for the other practitioners. I would have treated her the exact same way. If she did not improve I would have then pursued autoimmune disease such as vasculitis and related conditions. But the presumed Bactrim allergy is common and is not the fault of any practitioner in this really quite uninteresting case. Dr Sanders ... this was not one of your most interesting pieces.
33
I've traveled a lot in my lifetime, that's a lot, beginning in 1965, when exposure to local bugs was the norm. Nothing ever happened to me other than malaria in India in the 80s. Thirty years later I got progressively numb and stiff until I had to call an ambulance. Two years later and endless antibiotics and other meds, only steroids worked, I'm back to health. Not one of the many doctors, maybe fifteen or more, I consulted, from many specialties was able to figure it out. So why am I writing this? My theory is that if we are in contact with many cultures and we're young, the local bugs will get in, go dormant until one gets old and the inmune system not so good and then they show up.
21
Hmmm. Both me and my daughter have had rashes after taking penicillin. Now we take alternatives. No rash.
9
"She had been traveling in Europe and Asia with a school group and was on her way back when her throat started to hurt."
Her home base is New Haven, Conn. Was her "school group" composed of Yale University students? Were her various clinicians affiliated with Yale School of Medicine & its teaching hospitals? She bounced from a "doctor in training" at the infirmary — fancy phrase for medical student, to an ENT, and then to an ER.
No one asked whether any of her school group partners were feeling ill. If, as Joe from Tampa suggests, the patient had acquired typhoid fever (a food-borne and contaminated-water-borne infectious disease) while abroad, some of her traveling companions might have gotten sick as well. That would have been a helpful data point, doncha think?
For typhoid, Dr. Wiki would prescribe a fluoroquinolone or a third-generation cephalosporin. It'd be interesting to know if either of the first two antibiotics were of these types.
The thing that I find most disturbing isn't that Dr. Sanders presented an unsolved case that cleared up on its own, on which basis the article is something of a cheat. What's disturbing is that the clinical personnel didn't get to a diagnosis, a proper treatment, and might have left the possibility of other patients unidentified & untreated.
Is there a Doctor House in the house?
43
It is terrifying that the patient saw a nurse practitioner and a trainee without mentioning any actual supervision by a more experienced MD—all leading to trip to a very busy ER. Mismanagement from the get-go. I hope she finds a better medical practice who really help her. I hope NPs get better.
31
Typhoid. Go back and re-do the blood work. It does go away by itself, if the person survives.
13
So what was the root problem. that resolved on it's own? Another case of guessing which made the poor girl sicker.
8
Probably a very bad case of sinusitis.
Sinusitis can and often makes a person feel very ill, plus she is allergic to mold; mold is found every where.
Bactrum can cause severe skin reaction including Kawasaki’s disease with sore throat and even damage to the heart in young kids.
2
Whatever happened asking questions, consulting research and getting to a proper diagnosis?
13
I don’t understand the purpose of this article. No diagnosis, several wrong treatments and no explanation for the initial symptoms. BTW... Bactria is a potentiated sulfa drug, and and particularly stronger than the average antibiotic
24
@Warren Antibiotics are dangerous and don't always work, I think that's the issue. Wishing some one had followed her medical treatment better and she might not have taken all those drug. Allergic to sulfa and sinus infection? Sounds like what happened to my daughter years ago.
6
It very much sounds to me like she had a viral illness - I would say the flu, but they must have tested for that, so a bad cold then - and then was given a series of antibiotics for that which of course didn't help. I have no idea why she was in so much discomfort she couldn't sleep without a pain killer, but that's my best guess. For those complaining about how there's no real definitive answer - that's actually very common in medicine, though it doesn't make for the most satisfying article.
9
So I guess the moral of this horror story is: Never take antibiotics, even when they’re prescribed, because they can kill you??!! I have asthma and chronic sinusitis, and sometimes the mildest illness can swiftly turn into something that needs antibiotics.....otherwise it’s a slippery slope to weeks of treatment with cortisone for asthma, which for me is a horrible experience. Because of stories like these, it’s a struggle when people like me are confronted with doctors who don’t know us and go by instruction manuals written for people without chronic diseases to get antibiotics when we really do need them, and we sometimes do.
17
The majority of health care workers know next to nothing about the drugs they prescribe. Wake up. Stop treating doctors like gods. Do the research, it's out there.
17
Wait, you’re not gonna tell us what she’s allergic to and finish the story?
15
I’m not sure I understand the point of this article. No diagnosis. No explanation for the initial symptoms. No real resolution of anything. BTW... Bactria is not a particularly strong “antibiotic “. It’s actually a potentiated sulfa, which is neither new, nor particularly more effective than many other available drugs.
19
The fact that the ENT prescribed antibiotics again, even after everything she went through, is crazy!
17
My reaction at the first mention of Bactrim was "That's the one that gave me a rash...."
Off-hand this doesn't read as a medical mystery solved, but rather a case of a doctor finding *a* solution to *a* problem and declaring it *the* solution to *the* problem. She was sick before she started taking Bactrim and she was sick after stopping taking it.
18
This happened to me when I was in college too (circa 2007)! I had mono and a doctor at the school prescribed me an antibiotic and a steroid. A few days after I started taking the meds, I woke up incredibly exhausted, struggled through a whole day of class and then by evening had a full body rash. I dragged myself to the ER and was given a benadryl iv, which cleared everything up. It was a nightmare. I didn't have pain and wasn't particularly itchy, but I looked AWFUL. I feel for this girl! Doctors prescribing both of these should advise patients that they can interact. I had not clue until I got to the ER.
10
Sounds like she had a sinus infection with a fever. Sinus infection would’ve caused all that congestion in her head including her ears. A fever would have caused the exhaustion and pain in her joints. That isn’t to say she shouldn’t have gone to a doctor after having symptoms for two weeks. But the doctor should have resisted the urge to throw antibiotics at her. They should have prescribed rest and fluids. Sinus infections can last for up to eight weeks. They can really knock you out. We need to figure out how to make space for being sick with run of the mill illnesses in this country. We need less drugs and more rest.
6
@Referencegirl And the electric shocks down the legs?
12
@Maragret M. By then she had already received treatments so it is likely the electrical shocks down the legs were a side effect of treatment.
I too had this reaction to Bactrim many years ago. I was prescribed it for a UTI. I spiked a fever and had muscle pain in my legs which made it almost unbearable to walk across the room. I stopped the medication and the fever and pain went away within 24 hours. At that time I was told that this was not a known side effect of the drug. I was later prescribed the same medication and had the same reaction. I now list Bactrim as a drug I'm allergic to. This article confirms my experience and suspicions.
13
Sinusitis is the last refuge of a scoundrel.
It is a diagnosis given when the physician does not really know what the diagnosis is.
Since the patient's symptoms went away the presumed diagnosis of a drug reaction seems correct but the severe myositis must be a rare symptom of a drug reaction.
I would have been interested in what the blood level of CPK was.
2
As soon as I started reading this article, I knew the woman had allergies which were what was causing her original symptoms. Why didn't the doctors?
3
@Deborah Lee No, it could have also been a virus. Less likely bacterial given the constellation of symptoms.
4
Although many commenters described this medical mystery as a weak example for an article, I find @Anders from Sweden's comment the critical reason for publishing an article like this: do not prescribe antibiotics until diagnosing what the bacteria is that's causing the infection. Not only is the danger that the patient will not get well, and will get worse- the danger is the exponential growth of antibiotic-resistant bacteria. The onus here is not only on the prescribing doctors, the onus is on patients who demand that their doctors yield to their evidence-free demands for antibiotics!
20
Sure it’s the patient’s fault. What a ridiculous statement. The doctor went to medical school. If antibiotics are indicated the doctor should say no! I’m sick of professionals blaming their clients for the problems they are bing paid to deal with. Many doctors prescribe because they get paid to and I don’t mean by their patients. I blame the doctors and big Pharma for what is happening not only to this patient but to the rest of us.
9
@common sense advocate Part of what you said is not right. It is not true that we should figure out which bacteria is causing an infection and its sensitivities before treating with antibiotics. This may sound like common sense to you, but it actually would be very impractical.
Take pneumonia for example; obtaining a high quality specimen of sputum from the lungs just by having the patient cough up gunk is very difficult. More often than not the result is just contaminants from oral flora. You can get a high quality specimen by doing a procedure on the patient, but that has risks and would be expensive. It's much better just to cover for the usual pneumonia bugs and add additional coverage for patient specific risk factors (e.g. COPD), which will be effective most of the time.
Another example is bacterial meningitis; we can reliably get a sample to grow the bacteria in this case (by doing a spinal tap), but waiting to start the antibiotics until a result is available increases the risk of death or brain damage.
In the case of UTI, sometimes it's a good idea to wait for a culture, such as if you're not sure if the patient really has an infection. However, if they have obvious symptoms of an acute urinary infection, then studies have shown it's effective to just treat them empirically.
12
@common sense advocate
Antibiotic Rx for sinusitis and URIs are initiated by diagnostic algorithms, not by culture results.
Treating viruses with antibiotics won’t be effective and can cause resistant bacteria to over grow and cause seconday bacterial infections. (Like sinusitis)Better to wait 7-10 days before starting antibiotics for sore throat/cold/cough symptoms.
4
Right away I thought “this sounds familiar.” I have raging sinus/cough problems in the Fall. I’ve been prescribed all the drugs and even told “it’s all in your head.” Finally properly diagnosed with an allergy to multiple molds, I am building up an immunity through mold-shots once a week. Fingers crossed next Fall is better.
18
@Lakeland Lady - “it’s all in your head.”
I had a doctor like that once. I saw him twice a year for blood work for my HIV. I kept telling him that I must have AIDS dementia or something because I kept waking up in puddles of urine with a bit tongue and feeling like someone had worked me over with a bamboo cane. My roommate was finding me passed out on the floor. I was having incredible memory loss (like couldn't even remember my oldest kid's date of birth). His response was that my t-cells were fine and that there was nothing wrong with me. This went on for 4 years until he told me to go see a shrink because nothing was wrong.
About two weeks later, my roommate took video of me flopping around the floor while he waited for the EMTs to show up to the house the second time in one day. Hours later, when I came to and he explained what all happened, he handed me his camera and told me to show it to my quack and see if he would finally believe me. He sent me to a neurologist who took a very simple EEG and told me to see a shrink. The shrink told me he had seen the EEG and that I needed an anti-convulsant and that he had no idea why they had referred me to him.
Turns out that I have severe frontal lobe epilepsy and was having grand-mals at least once a week. Yeah, its all in my head. Too bad everyone let me drive my van in that condition for 4 years.
Yes, I left the quack and his hospital and found new doctors.
7
It is very common to have a change in bowel habits after taking courses of antibiotics. Our stool is actually mostly shed bacteria.
Can you imagine how many bacteria must live in our intestine in order for that to be true?
Those bacteria that ARE alive in our large intestine help us digest food, but set up their own little ecosystem inside of our colon. If a bunch get killed off by antibiotics, taken orally or intravenously or by ANY route, the balance changes and we may have diarrhea or at least excess gas or some kind of upset.
That's NOT lactose intolerance.
6
Actually I was given a generic form of clindamycin that used lactose as a filler. I never had a problem before with this drug. With the first dose I felt as if I had lactose intolerance. I researched that particular formulation from India and indeed it had lactose as a filler. For the duration of my treatment I used
lactase and those symptoms were controlled. I called the drug manufacturer and complained. Notified my pharmacist and my insurance company. (I’m a retired nurse-anesthetist)
6
@Nancy Sculerati MD And that's why I drink kombucha and eat sauerkraut while and after taking antibiotics to try to restore my good bacteria.
This young woman was ill for three months. Granted she was inappropriately prescribed antibiotics and had an allergic reaction, the diagnosis was not established and she recovered despite, not because of, the treatment she received. Hardly a triumph of modern medicine!
14
I went to my doctor an internist who had recently arrived from residency in New York but was from another country. I was complaining of a lower stomach pains. She put me on three antibiotics which had no effect. Other than to cause diarrhea for several months. Couple of years later a drove a nail through my finger using a nail gun. Went to an emergency room who wanted to put me on an antibiotic drip and keep me overnight for observation. I left there and went to another emergency room and they wanted to do the same thing. Because my insurance covered little of this the episode ended up costing me around 3k. I felt like I was a car and these doctors and emergency rooms were the last chance gas station on the edge of the Mohave desert. These events took place in the last 5 years. Don’t these physicians read? All three of these events happened in the twin cities where we pride ourself in our medical chutzpah. Now I simply dread going to the doctor.
6
So even though the young woman had taken courses of antibiotics that had no effect and the last course of a stronger antibiotic didn’t help but also gave her a terrible reaction, the same ENT doctor prescribed yet another antibiotic?! What a great doctor. Amazing.
4
@JW
I couldn't believe she went back to him!
1
Strong reaction to toxic mold? Mold is everywhere,
after all...
From my experience, I’ve come to the painful
realization that most doctors do not take the
possible toxic effects of mold seriously....
8
I've found that by carefully researching on the web I can gather more and better information than I would from a doctor. Yes, search the web, just do it intelligently. More than once, had I followed "doctor's orders" and not researched, not thought outside the box, I would have continued to be sick, and in debt.
3
@Urban.Warrior - I too, am getting better health advice from YouTube. And the woman in my building who was a doctor in China but is now in medical school here in the U.S. I talked to her once in the parking lot about my symptoms and she nailed it without a single test or even touching me. My doctors are located at the school where she studies and it took them several months, an MRI, some 90 minute electrical test to reach the same conclusion. And by the time I got in to see a physical therapist, I had already learned what to do from some chiropractor on YouTube who showed me the same exercises they did.
5
Ok genius, so what was wrong with this woman? Ask Dr Google.
5
The routine mantra to treat things with antibiotics is VERY problematic. First, many infections are managed fine by our body’s internal mechanisms. Second, for many infections, no effective antibiotic therapy exists. Third, the more antibiotics are used, the more we cause resistant microbes to evolve. Fourth, antibiotics cause problems as seen in this patient.
An alternative is needed that offers help against infections when the patient needs it without leading to resistance.
To develop these therapies requires that we study the normal biology of both microbes and hosts to understand their interaction and how to manage it to avoid harm to the host.
As this doesn’t immediately or necessarily lead to a money making business, it hasn’t received much support.
Stephen Rinsler, MD
13
@Stephen Rinsler I was constantly getting sick and what helped me was a dTap booster vaccination and Vitamin-D supplementation. It's amazing that a lot of doctors overlook this important vitamin which is extremely important to the immune system. At least 55% of Americans are deficient in Vitamin-D!
The fact remains that a LOT of serious health issues people experience are never accurately diagnosed. The healthcare providers are left treating the symptoms, or worse, blaming the patient for being ill. For physicians, a condition undiagnosed doesn’t exist.
In the end, many of us (in the US) are eventually left to pay the exorbitant bills, and to cope and live or die in our own.
8
"She had been traveling in Europe and Asia with a school group and was on her way back when her throat started to hurt."
Extensive travel can be very stressful for one's immune system. If her immune response was poor, many of the symptoms would appear. No surprise that the steroid Rx was the only helpful Tx. Bedrest, fluids and a high-quality diet will work fine if given a chance.
8
I guessed to myself that it sounded like allergies when the story first started. As soon as dots on the skin was mentioned I knew it was allergic reaction to antibiotic. Why? I am highly allergic to tree and grass pollen. I can tell when my allergies are the cause of sinusitis. I'm also allergic to most of the common antibiotics and I've seen the dots before. I had a reaction in the hospital once and the doctor thought it was the sheets. I thought otherwise. The nurse thought it was the antibiotic. It was the antibiotic. If you understand your body, speak up.
20
Three antibiotics in rapid succession? And we wonder why there are increases in the # of illnesses that are antibiotic resistant? Also I’m curious about the length of time actually spent with the MD per spot. 15 min or less as mandated by many insurers?
17
Why prescribe antibiotics in a well looking person without doing any tests? Sinus infections are notorious for not responding to antibiotics. Bloodwork, viral study by PCR make more sense.
8
My son who is 11 has allergies and developed a sinus infection. He was treated with an antibiotic and started acting very strange and not sleeping. I didn’t know that antibiotics caused these kinds of reactions, but apparently they can.
I’m in the process of finding a new doctor who will help us explore ways to manage his allergies without so many medications. There are side effects to all of them. It is hard to find a Dr. who is open to and knowledgeable about alternatives.
9
I used to get many sinus infections that would turn into bronchitis. I suggest your son (with your assistance if necessary) start regularly using a Neti-Pot or Neti-bottle for warm saline rinses. Very effective and low cost. You can find them at any pharmacy. A Nurse Practioner told me about this after many years of suffering.
23
Neti pot only exacerbated my sinus problems, I threw it out.
What helped was a hot shower, letting things warm up and then gently blowing my nose. Works almost every single time. One or two visits to my acupuncturist also help.
7
@Urban.Warrior , Similar, a sinus and chest infection cleared by acupuncture treatments (after 2 courses of antibiotics didn't help).
First treatment and I left the office being able to breathe.
1
Today’s doctors are losing the intellectual tools to conduct, comprehensive, open-ended diagnoses - in favor of pushing cookie-cutter panaceas - among them antibiotics and steroid dosepacks. Would the treatment method have been more effective if the patient’s allergies been given greater consideration at the outset? Quite likely.
9
I don’t get it. She had symptoms before taking any antibiotics. I don’t think she’s been cured. I wouldn’t be surprised if the symptoms return.
26
@Queenie The human body has exquisite abilities to respond to and defeat infections. It takes time for our system to develop responses to new (to us) invaders. Sometimes these native abilities are not sufficient and medicines are useful. And sometimes nothing works. But we walk around in a very efficient self healing system.
2
This case exactly demonstrates why I've given up on conventional medicine, except to glean information, and the broken system that has resulted. The breakdown has been in the works ever since the mid-90's when the insurance industry and the pharmaceutical industry decided to make health care a for-profit business, stock market included in the getting rich scheme. Both doctors and patients were/are held hostage to this system of approval and credentialing, apart from any recognition that helping and caring has always been central to such a life-choice of service.
I have my own stories, similar to this one, and I know I speak for many, when I say we have all learned "the hard way" to be our own researcher and our own advocate for ourselves and for our patients.
My favorite book on keeping a perspective on what's important is "Having Our Say" by the Delaney sisters, who lived to be 104 and 106. They ate garlic, did their morning yoga, baked their cakes from scratch, made friends in their neighborhood, and gave sage advice such as "Don't go to the hospital, they'll kill you." They were truly ahead of their time.
23
@Linda Collins Thomas, MSW - I’ll speak for many in saying that I, a breast cancer survivor of twenty years since dx., am alive thanks to modern medicine and pharmaceutical science. Not to mention vaccines that prevent polio and other life-threatening diseases. The Delaney Sisters you mention lived very long lives not because they ate well and did yoga — yes, this may’ve helped — but because they had genes that enabled them to live long lives — and because they were just plain lucky. I hope you don’t suggest to people who have life-threatening illnesses that they avoid doctors or hospitals.
45
If done carefully and intelligently, one CAN successfully use the internet to search and diagnose. Unless it's literally broken, I avoid the doctor.
3
@A Dot. As an asthmatic I am also alive due to modern medicine. I think the takeaway is to do your own research, get to know your own body and take medical interventions with a grain of salt. Doctors are there to help you but you have to be an active participant in your recovery. Don’t put blind faith in the medical establishment.
17
Beware clindamycin. I had a tooth removed three years ago and they gave me a one week supply of clindamycin “to prevent infection” and then decided to add another week’s worth during the same appointment. I was 67, and I got a severe case of C. diff colitis. I lost 10 pounds from my 138-pound body, had a constant headache and was losing liquid from both ends. I once woke up leaning over the kitchen sink. Later, I read that older people should not take clindamycin. I called the dentist, and they were vaguely surprised.
24
@Susan Harls Oral surgeons very often prescribe clindamycin after surgery, and apparently seem unaware that clindamycin can cause C. diff. (whenever it is dispensed by most pharmacies - CVS, Walgreens, and Duane Reed - the drug is accompanied by a document warning of the side-effects of clindamycin, which _always_ begins with the possibilities of chronic diarrhea and C. diff.)
I can only assume that many of the schools attended by graduate students who aspire to become practicing dentists, oral surgeons, endodontists, etc. do _not_ emphasize the dangerous side-effects of the medications that they generally recommend to their students when they will need to prevent post-operative infection.
Your problem after being prescribed clindamycin by your oral surgeon has unfortunately been experienced by more than a few dental patients.
4
@Susan Harls
I have a similar story after a routine dental procedure, with that same antibiotic.
3
@Susan Harls Similar thing happened to me after a tooth was pulled and I was given clindamycin by the oral surgeon to ward off any potential infection. Terrible GI symptoms appeared almost immediately, so I stopped the clindamycin. My gastroenterologist was consulted. He said the symptoms would abate; leave well enough alone After months of suffering I found a high potency probiotic. One pill and I was cured! I now no longer think of myself as an individual; I am an army of little microbes hanging out in my GI tract.
5
When my daughter was five years old she contracted Fifth’s. Other than pretty pink cheeks she was fine. But I got sick after that and I had no rashes or pink cheeks but the fatigue I felt was like no other. I could not pick myself up, driving was stress inducing as I felt so scared of the fatigue. My thyroid was off as indicated by a TSH reading. None of the docs prescribed antibiotics and all kept pointing to my TSH of 6. In fact none cared to wonder about my fatigue or why it had begun. I did not think to connect it to my kid. It took many months of recovery to get back to normal, TSH included without drugs. No doc ever told me I had Fifth’s and I thought it to be a possibility only in hind sight. I say she got a childhood disease from her school group and the antibiotics totally affected her chances of recovery. Why on earth do doctors not consider the fact that children seem less affected than adults when exposed to childhood illnesses?
5
I have had a similar experience in the last few years. In 2016, I had cold/flu symptoms that lasted for months. In the end, they prescribed me two courses of antibiotics. One doctor said I had pneumonia, other said I didn't. Another doctor casually mentioned that I might have allergies. I am one of those patients in whom the symptoms of allergy and a cold virus seem interchangeable. I can't tell the difference, and it appears nor can the doctors. I am having the same dilemma this year. I had a cold virus, (I had a flu shot in the fall) it got better, but then it seemed to relapse. The doctor said I had sinusitis and prescribed an antibiotic. That seemed to make it only slightly better. I went on a vacation in Mexico and when I came back, the symptoms returned. I am now guessing that I have allergies and trying anti-histamines on my own. I wish the doctors could make a better diagnosis so I could avoid weeks of suffering.
6
I'm currently taking an antibiotic (day 4 or 7) and have developed insomnia. I tried to Google whether these drugs have that side effect, but didn't find anything. But, it started the same day I started the pills, and normally I am an Olympic-level sleeper, with no history of sleeplessness. I plan to call my doctor today to see if he'll switch drugs. Antibiotics are weird drugs.
3
@Ms. Pea
Just a tho't: you are part of the way through with the antibiotic you are on already, and you don't report serious side effects. Is the drug having the desire effective on your infection? If so, why not just finish it and then wait. Adding one more drug - IMHO- runs the risk of compounding side effects.
Last fall, a friend developed with a condition similar to that described here - a burning, itching, flaming red rash that had her referred to a round of Drs. for a diagnosis which only in hindsight was attributed to a multi-antibiotic course of treatment - - where a specific drug could not be identified as the trigger, I suspect keeping it as simple as the condition allows might be prudent.-
I also wonder if those who have chronic conditions who may be prescribed antibiotics often ( relative to healthier people) become more susceptible to this type of reaction. That didn't apply in this narrative, but it would be of interest to know.
1
@Ms. Pea
They are. And the people prescribing them rarely mention the side effects, which are common and frequently predictable.
As a young women I was prescribed antibiotics multiple times. Not once was I warned that they could prevent my brith control from working! By chance I didn’t get pregnant.
When the vet prescribed them to my parrot, he always included a fungicide as well. But women are rarely given that option despite repeated fungal infections after taking antibiotics.
And for those who would deny us all access to antibiotics — that story changes with cancer. Cancer treatments pretty much end your innate resistance to infections. Me, I can let my body do the fighting. My husband would be dead without antibiotics.
1
Be VERY creative in your google searches and you will find information.
2
10 years ago, i was prescribed a course of zpack for a fever and chest congestion. i turned red, puffed up and broke out into hives all over my body. i had never heard of zpack, and no one mentioned that if i was allergic to erythromycin i should not be taking zpack. somehow they missed that i was allergic to erythromycin in my records. then i was prescribed steroids for the allergic reaction, which helped. it all cleared up in 10 days.
since then i try very very hard to not take anything other than natural supplements, antibiotics especially. i am horribly allergic to poison oak, and that is the only time i will risk steroids. oh the agony of the systemic itch!
i’ve had the flu for almost two weeks now and i am finally slowly on the mend. grateful i have been able to stay in bed and let it run it’s course. literally the last thing i want to do is go to a western medical doctor for anything other than a broken bone or a torn something - big thank you to my orthopedic team for my new acl a few years back!
8
@pilar woodmam
A Zpack is simply a pre-packaged dose of Azithromycin, which is related to erythromycin.
1
We used to think there was no harm in prescribing antibiotics for conditions where they were not indicated, viral colds, seasonal allergies,etc. because there a few bacterial illnesses that can progress from mild to deadly symptoms unexpectedly. There is also the problem that it is sometimes difficult to explain to patients with limited medical knowledge who are obsessed with antibiotics because they adhere (like some medical staff) to the school of "that's the way we have always done it". This leads to the anathema of modern "patient centered care": patient complaints. We have learned that there are multiple possible adverse outcomes associated with indiscriminate antibiotic prescription. The decision to prescribe antibiotics when they are not clearly indicated can be a difficult decision. There adverse outcomes to be considered with both courses of action. The current restraints on medical decision making is driving clinicians out of practice. Most of us do not intend to play God but that is often what is expected.
12
@Gregory West
Many drug companies have been going out of business recently, because their anti-biotics are no longer effective (if they ever were).
We often think of bacteria as individual pests, which can be killed individually, one after the other. That is a naive notion. Aside from the fact that new strains evolve (as in classic evolution's "survival of the fittest) and are not longer affected by the drugs. But there is a more serious problem than new strains evolving, and that involves the more complicated nature of bacterial growth. It's too scary to describe here, but many bacteria form colonies acting more like new and more complicated meta-organisms. But wait, there's more: these colonies expand into "biofilms", a state which is even more resistant to erasure. Again, too scary to contemplate here. Look it up.
3
No mention of a bronchoscopy to seek specimens, for lab culture, of the offending organism. Why, in a bronchial infection this severe and long-lasting? Would that not be indicated before deciding which antibiotic might work best -- if indeed bacteria rather viruses were the cause?
12
@Willy The Quake
Results of chest imaging is not mentioned. Yet if xrays are negative and cough is the only pulmonary symptom, there’s no value in antibiotic treatment so no value in bronchoscopy.
5
@Charles Carter : No mention of of chest imaging result either! Good point. On what were diagnosis and antibiotic choice based?
3
From this article I confirmed my diagnosis (of the American medical system): that too often doctors do not know what is causing symptoms, and then to appear capable they just do "something".
If doctors were willing to notice those times when they get stumped, and at those times confer with colleagues outside their own practice, then the shared knowledge they gain (resulting from their willingness to admit their own imperfect knowledge) will help patients -- and society.
27
@Incredulous of 45 You have a fair point. But often doctors are not stumped - they have a theory which in the absence of definitive tests can not be conformed. So they begin treating the most likely cause, while anticipating they may be wrong. I imagine doctors would be most pleased if medicine was simply a matter of checking the appropriate boxes to obtain a reliable diagnosis. But we are not there yet.
5
It's time to for all of us and our first tier doctors to get serious about antibiotic resistance as a subset of antimicrobial resistance (AMR). Medications that once successfully treated the microbe are now resisting the effects of that medication. Antibiotic resistance refers to the same regarding bacteria that is (or is becoming) resistant to antibiotics.
And it's not a question of piling on antibiotic after antibiotic until the magic pill is found. Each antibiotic affects our immune system, it is said, for up to two years. This article indicates that antibiotics may have been (or was) this patient's problem. But what it doesn't say and perhaps what the patient didn't track is what tests were conducted at every stage of her increasing illness to determine whether and what bacteria, virus, or fungi was present. Antibiotics were only indicated if bacteria was present, and even then antibiotics should be tested against the particular bacterial strain for efficacy.
When I read of healthy and or younger persons dying of sepsis during a flu epidemic (viral), I wonder now if antibiotics had been given erroneously and caused such damage.
It's too complicated to explain in a comment, but this subject cries out for further education of us all. Antibiotics in general are not to be assumed our friends any longer. They can be deadly.
13
My 2-year old toddler developed pneumonia, was put on an antibiotic, seemed to be getting better, then developed the beginnings of ear infection. The pediatrician who saw her (not her normal doctor) switched her to a ten-day course of clarithromycin after she had already completed seven of ten days of her first antibiotic treatment. Within one or two doses, she began to break out in the same pinprick rash all over her trunk and extremities as described in this article. Her fever spiked dangerously, her breathing became worse (she was getting over pneumonia, and this was a marked change for the worse), and she seemed lethargic. By the morning after we noticed her rash, it had spread and become huge red blotches all over her body. The same pediatrician thought what my daughter had was Kawasaki disease, not a reaction to an antibiotic that was poorly tolerated after almost a complete course of another antibiotic.
Um, no. Within days of stopping the antibiotic her rash started to clear. Drug allergies like that are no joke, and doctors need to be careful with antibiotics: the notion that it was OK to put my daughter on antibiotics for the better part of a month makes no logical sense to me. We were sent to the local children’s hospital where the doctor we saw shifted my daughter back to the original antibiotic at a higher dose, for a shorter course.
We have to find other ways of treating bacterial infections than overuse of and over reliance on medications like these.
32
I had something similar happen to me in college - I got an infection and the doctor prescribed me an antibiotic. A couple days after finishing the antibiotic I noticed red spots on my back and developed a fever. I went to the hospital and they gave me Tylenol for the fever, said nothing was wrong and sent me home. The next day I woke up and my body was as RED as a stop sign from head to toe, including my scalp and in between my toes (might I note, I’m an African American so it was quite a shock for me to be actually red). The itching was unbearable and I went to the student health center (people avoided me like the plague) and the health center discovered I was having a severe allergic reaction to the previous antibiotics. They put me on steroids and a week later the allergic reaction was gone.
32
I'm a spine physician so this area is not my specialty but nonetheless, I'll chime in. These articles normally have a eureka! moment where an obvious complaint that was previously ignored was found to be pertinent and solved the mystery diagnosis. Here, the initial complaints were treated with resultant complications that were finally noticed when the patient developed a delayed rash. The original complaints that produced the initial visit and resultant treatment was never discussed and no treatment conclusions were made regarding the initial diagnosis. This article is somewhat weak due to the lack of initial diagnosis conclusion.
139
The eureka is that the woman returned to the college clinic and the ENT prescribed more antibiotic without checking for allergic tolerance. College clinics are notorious for poor handling of anything but simple colds. My sons, at different colleges experienced a diagnosis of fungus for what was actually shingles (yeah, that anti-fungal was a waste, and who knows how many students were exposed to the shingles before correct diagnosis by private MD) and over prescribing opioids for an incorrectly diagnosed dislocated shoulder. This female had traveled out of the country and had more severe symptoms. The clinic should have immensely her to a real doctor. Even though the travel had nothing to do with her problems, they didn’t know that.
23
@Peters How would you check for an allergy to sulfa? This woman went to many non doctors for medical help and surprise, didn't get it. But where is the medical mystery? Who knows what she was actually suffering from and let's hope she didn't spread it to the whole school.
2
@Donald S. Corenman, M.D., D.C.
I actually thought that the lack of that "Eureka!" moment was intentional.
A little bit of reality clinic tv.
The meandering, seemingly directionless way she was "treated" by throwing antibiotics at her --- and the lack of any defining diagnosis - - this happens every day. And I suspect there are more antibiotic reactions than known from the "throw 'em all at the wall and see what sticks method" of "treating" before reasoning..
4
Did anyone look for underlying autoimmune disease?
24
@Dr. Dixie That was my immediate reaction. It seems most are focusing on the sinus infection, not on the muscle weakness and headaches. I thought this was a glaring omission.
23
@Dr. Dixie
Isn't one of the issue with antibiotics is that some - for some individuals - may themselves become the trigger for an autoimmune reaction?
2
As Swedish, what strikes me is to prescribe antibiotics without ensuring a bacterial infection and, if possible, identifying the bacteria causing the problem.
In Sweden, antibiotics are used very restrictively, which have resulted in a comparatively low rate of antibiotic-resistant bacteria.
206
@Anders Happens all the time--because there is rarely time for MDs to review the symptoms over an effective time period: they jump to conclusions. My child almost died from overuse of antibiotics for the same reasons.
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@Anders
What's worse here is that antibiotics are used in healthy livestock to make them grow faster.
5
I was so described Bactrim for MRSA picked up on travels in Asia so this hits home. The rash I developed was more painful than childbirth. Ironically I was given bactrim because the other main antibiotic for MRSA is penicillin-based and I’d had some spots after taking amoxicillin as a teen. This ordeal prompted me to go get tested for a penicillin allergy and I am no longer allergic to it. The takeaway here being: there’s a test you can ask for to check for penicillin allergies and if you’ve ever had a reaction to penicillin before, I encourage you to get tested.
40
@Jenna I have an allergy to sulfa too. Ironically found out because I had a sinus infection and the doctor didn't want to use penicillin based antibiotics because of over use.
4
Thanks, I definitely need to have that test done after a long ago reaction to penicillin.
1
Living in Denver with its low humidity causes dust and bugs to get stuck and mucus to thicken (I'm not a Dr.). At least three times a year I was at the Dr. for sore throat, sinusitis, and/or a sinus infection and antibiotics. My story was similar and I had an allergic reaction to an antibiotic. A new Dr. started me on a twice daily sinus rinse. 5 years along, I've not had one cold, let alone a sinus infection.
29
@M.E. Realist hi, what is the exact sinus rinse? Medicated rinse? Thanks
@M.E. Realist, I love my neti pot.
1
And people wonder why American healthcare is so expensive.
Persistent mild respiratory symptoms in an otherwise healthy young person are, as we say in the trade (I’m a doctor), as common as dirt. Why on earth would a primary care doc refer such a patient to an ENT specialist? ENTs are surgeons. They’re good at resecting head and neck cancers, less good at the diagnosis and treatment of allergic sinusitis. For the patient’s trouble, she got an unnecessary diagnostic procedure - the nasal endoscopy - and an inappropriate antibiotic. Even had the diagnosis of bacterial sinusitis been correct, Bactrim was a poor choice. Resistance rates are high among Strep pneumoniae, the bug most often involved.
I don’t really blame the specialist, though. She/he likely would’ve felt bad sending the patient home with a pat on the head in exchange for the $300 consultation fee. What’s more, the Bactrim/steroid combo likely would’ve brought relief were it not for the adverse drug reaction. I’m more critical of the primary care physician. If as a family practitioner you can’t figure out grumbling sinusitis after what sounds for all the world like a viral upper respiratory tract infection, you need to do some serious self-examination.
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@Aaron Walton In the US, ENTs treat allergies, sinusitis, ear infections and many other non-surgical issues. You’re right that US healthcare has a lot of problems, but this referral isn’t one of them.
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@Aaron Walton
an ENT diagnosed me with infra orbital neuritis after a pt waking up from anesthesia punched me in the face. found out when I had my left cataract done the fibers had all been torn so the lens floated into the retina. so they do a good job some of the times.
1
None of my GPS has an endoscopy to view whether I actually have a sinus infection- so the EnT is who I seen when it is persistent.
I had a similar run of years fighting "sinus infections" with steroids, abx, and being offered sinus surgery by a rural ENT. A wonderful ENT at UNC-CH showed me how to use a nasal spray of salt and baking soda (neti pots are too much, he said) and recommend acupuncture. With that, the congestion would open immediately but I continued for weeks to keep the effect and heal the inflammation. That was 15 years ago and I've not had another sinus issue.
30
@mrs
nasal spray that you can mix (I boil the water filtered of course )and acupuncture. wish medicare advantage covered that.
One of my doctors prescribed a strong sulfa drug for me years ago because he said I had a gastrointestinal infection (I was actually hyperthyroid from postpartum thyroiditis). I've been lactose intolerant ever since.
6
@Catherine F
In 2007 a doctor put me on strong antibiotics for a staph infection because she could not manage to correctly diagnose shingles. I have had to take probiotics ever since.
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@Catherine F
My dear, (I am a woman MD and mean it in a sisterly/motherly way) you are NOT lactose intolerant from a sulfa drug. Unless your ancestors came uniformly from Northern Europe you are likely lactose intolerance because you are a human adult.
Like all mammals, we humans live off milk as babies but most of our species loses the ability to make lactase, the enzyme that breaks down milk sugar, in early childhood.
Somewhere along human evolution, a mutation in the gene occurred that was favorable for those who carried it - these people CONTINUED making the enzyme all of their lives.
That trait is VERY COMMON in Northern Europeans. My family - both sides, back until at least 1600 AD, do NOT have it. I loved milk as a child, still do. But for the sake of those who must breathe the air that I would otherwise contaminate with gaseous discharge from my bowel, I use artificial enzyme supplements like Lactaid and DairyEase.
Please try it.
5
She should take a break from eating dairy and possibly gluten. That will most likely clear up the congestion and sinus issues. Take a good quality probiotic to replenish the intestinal flora killed by the antibiotics. Get a blood test to check nutrient levels and potential allergies. Get some rest and eat lots of fresh veggies and fruits, whole grains. If these changes don’t help, she can do further testing but she should try simple dietary and lifestyle changes first. Prescribing a pill is not always the answer.
17
@MCMOM I agree with most of your comments although grains are not as good for you as we are told. Anyone with Colon issues are told to avoid them.
Eat good quality meat, yes avoid dairy, natural probiotic foods are best, avoid pills. Lots and lots of water, light exercise, avoid stress. Lots of sleep.
6
My son now has a list of 5 antibiotics he is allergic to. Reactions started when he was 12 or so, a strep throat, treated w/antibiotic put him in the hospital for a heart reaction, though it wasn't recognized at the time. New antibiotic, gets worse. Repeat, etc.
Finally, one doctor suggested NO antibiotics, take him off of everything...he got better.
He's now 40, and we reserve any new antibiotic for 'near death' scenarios only, figuring he may only have a single use before a reaction.
19
I agree with Diane, OH. This sounds a lot like granulomatis with polyangiitis (GPA, formerly Wegeners), a very rare autoimmune disease that is notoriously hard to diagnose and for which the first symptom are often sinus issues,fatigue and joint/muscle pain. The steroids may have put her into a temporary remission but a relapse could be devastating. I'd suggest she be referred asap to a Rheumatologist, preferably one with ANCA vasculitis experience.
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@Annie P interesting call. Did she have any rheumatology workup while in the hospital? The long lead time on her illness doesn’t sound like “just allergies” to me either.
3
@Annie P And your credentials are what? She has allergies, and a drug reaction, and you diagnose PGA\Wegeners, a rare autoimmune disease on the basis of that?
You may be right, or wrong. But diagnosing on the basis of a newspaper article can be dangerous, for the patient and everybody else. FYI, Rheumatologists arent the only ones who can make that diagnosis. And most of them will never see a patient in a hospital.
2
@Annie P You sound very well-informed, who would doubt you? If I were that student, I'd bring a printout of this response to my doctor immediately! (Should I assume you have medical training or are you just an extraordinarily capable internet detective?)
So what was the original problem, not the 3rd problem which was the result of the antibiotic? Did anyone figure that out?
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@Allison "As for what was causing the congestion and sinusitis — Juthani told me that she thought it was probably allergies; the young woman had a known allergy to mold. Or maybe a couple of back-to-back viral infections. But it wasn’t a bacterial infection."
"All her symptoms cleared up a few weeks later."
1
@Allison "As for what was causing the congestion and sinusitis — Juthani told me that she thought it was probably allergies; the young woman had a known allergy to mold. Or maybe a couple of back-to-back viral infections. But it wasn’t a bacterial infection."
"All her symptoms cleared up a few weeks later."
@Allison No. I wondered about that too. What was causing her to feel so terrible even before the antibiotics?
1
Good grief! Sinus? Congestion? If the abx aren’t making the patient feel better what about holding off on the big guns and trying saline nasal spray, a Netti pot, a humidifier, steam baths and Mucinex? Throwing abx left and right aren’t helping the patient!
Also, seeing multiple specialists can complicate a picture. Her primary care physician could/should have been the leader so she could get some coordinated care.
I developed serious hives with Bactrim. Beware! Sulfa drugs are now on my allergy list. She’s lucky she just had those spots. There are cases of sulfa reactions that are far more severe.
54
I am so conflicted reading this article. It is clearly a case where antibiotics were simply thrown at this patient with no follow-up. I am a healthy person not quite in her dotage and have been treated with antibiotics very few times in her life. Well, except for the 5 times when I had Lyme disease. Yeah, I know. Which of course means that I have a love/hate relationship with antibiotics. I’m sorry this young lady had such a miserable experience which, I’m sure, she will never get past
8
do any of you that read Dr. Sanders columns know of any way to treat claudication without an artery transplant? The artery has a restriction behind the right knee joint, I am told due to the location, a stent can not be used. I am 85 and do not think my system can grow a bypass very fast if at all. It is like having a permanent cramp in my calf, and a painful ankle after walking about 100 yards or so, and also causes a pain at the hip joint.
I am supposed to exercise but it does not seem to help much. Is there any current treatment for this that can open the artery? I am told a bypass in the area will not work, because of the flexing of the joint. Email: bike2sac at surewest dot net, any information will be greatly appreciated.
6
Mr. Underwood, Sorry for your discomfort! Contact a geriatrician who’s an internal medicine doctor who specializes in treating older folks. Best of luck!
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@David Underwood This is a bad location to have an arterial blockage. Stenting is not reliable for this area, as you said due to bending of the artery, or stent, itself with movement. However, you do not "grow" a bypass, and technically speaking surgery would not be considered a transplant (no immune suppressant drugs typical of say a kidney transplant are used.) I believe you mean that by exercising other arterial vessels in the area would enlarge to accommodate the needed blood flow, and you're right, that might not occur at your age. On the other hand an "extra anatomic" arterial bypass (using an artery or possibly a vein from from another site in your body) can be done but would be placed off to the side of the back of the knee so as not to crimp when you bend your knee. The surgery isn't easy, but isn't particularly hard either; and recovery depends on your general health.
I suggest talking to a board certified vascular surgeon for actual details, this is not my specialty.
12
@LesISmore Actually, graduated exercise increases oxygen tisue demand, causing new blood vesels grow around the restricted area of flow. In other words, the body responds by making new vessels (neovascularization) to go around the obstruction.
I am not a doctor, but over the years I seem to have developed reactions to antibiotics that I was given years ago. When I was about six I got impetigo. I was living in a small rural town in California, we had to drive over the mountain to Calistoga, the treatment was something called jensen violet. The doctor said I needed to be cleaned better, so I took baths for years with lava soap. But I developed boils, which lasted for years, when I was 13 I was given sulfa, which was a new drug at the time. Now sulfa makes me feel ill. About 33 years ago I developed diverticulitis and was treated with amoxicillin. I have been taking a mucilage since, but several years ago I detected the signs of it again, but when given that drug I developed a reaction to it.
I do not get the kind of reactions that require emergency treatment, just things like constipation, headaches, feeling ill, some intestinal uncomfort, so aging seems to have increased my sensitivity to these drugs.
4
If you cannot find a geriatrician in your area you may want to see a family medicine doctor. Best of luck.
7
@David Underwood I think that early treatment was gentian violet. Many years ago it was also used to treat oral infections.
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@David Underwood
It's gentian violet.
Sinus infections unresponsive to multiple antibiotics can also be a sign of the autoimmune vasculitis disease granulomatosis with polyangiitis (formerly Wegener's). Several of her other symptoms fit GPA too, though she likely would have improved on steroids. Did she have an ANCA test?
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@Diane
Thank you. I have rather severe lupus and often appear with crazy infections that often defy my phlanx of specialists. But the concert of docs works together, before meds are given by anyone, they all have their say, with my rheumatologist at the head of the team.
reading her symptoms, it seemed to me that she was suffering from some sort of suppressed immunity or autoimmune disorder.
The kind of care immune disorders probably defies the broken American medical system
8
@Meeka Sorry to hear of your issues, glad you have a "team" that works together.
I caution you, and @Diane against making a medical diagnosis based on this article. It may be no more than what was presented: viral syndrome, complicated by (overzealous) antibiotic treatment and a drug reaction. I've been there, had that, and I dont have "a rare autoimmune disease.)
1
@LesISmore Neither Diane nor Annie P. made a medical diagnosis. They merely suggested a possibility. A year ago, my formerly good health was impaired by three weeks of a bad cough, followed by four weeks of a bad sinus infection, followed by a vasculitis rash on my legs, muscle aches, and blood in my urine. My PCP did a thorough work up, including referrals to a urologist and nephrologist, and bloodwork testing for markers of GPA, lupus, and other autoimmune disorders at my request. She had never heard of GPA, and dismissed my concern at first, then changed her mind after consulting with other physicians. Thankfully, my strange constellation of symptoms resolved without steroids or other medical interventions, and one year later, I am in good health with no relapses. I suspect I may have had IGA vasculitis, but by the time I got into to see the nephrologist, my blood cells were normal, not misshapen, so no active kidney inflammation that could be verified by a biopsy. IGA vasculitis often clears up on its own though adults are more often likely to suffer complications and need to be monitored like my nephrologist did with me for several months before dismissing me from his practice. GPA is often missed because so many other things can cause ongoing sinus problems and rashes. Diane and Annie are right to suggest this possible diagnosis in comments read by many others interested in this case.
4
Were any of the antibiotics in the fluoroquinolone class (Levaquin, Cipro, Avelox, etc.)? These are commonly prescribed drugs that the FDA has labeled as drugs of "last resort." Go to the FDA website and look them up. Be an informed patient. Don't end up with debilitating, permanent side-effects like so many thousands of us. Doctors know a lot, but they don't know everything and drugs this potent and potentially dangerous should NOT be commonly prescribed!
31
Her symptoms don’t match known quinlone problems - I’m very up in this because I had a bad reaction in 2002, before all of this was known. That being said, I am appalled at how often doctors still prescribe CIpro for people who will be traveling, in case they have stomach problems. And this for a drug class where yet another set of black box warnings were just mandated.
22
Levaquin prescribed for a sinus infection resulted in tendinitis in both shoulders, never fully healed years later. Fluoroquinolone antibiotics should be a last resort. Patients should be adequately informed of the potential risks by the doctor, before prescribed, as well as other options for treatment. Would like to see our MDs continue to expand their treatment protocols to include non-pharmaceutical solutions. Have found saline works wonders for sinuses.
6
@Nancy Too true, and especially if you're getting prescriptions from a nurse practitioner! I don't care what they say, it's not the same as an MD.
Regarding her primary illness that seemed to resolve on its own (despite three rounds of antibiotics) and the doctor's desire to "do something"....
Part of the issue is that we, Americans, don't allow ourselves time to be sick (slow down, take off work or school) unless we are basically bed-ridden. I recently was hit hard with a virus and ended up missing five full days of work. I was apologetic, upset that I was "letting colleagues down" and peaked at my email nearly ever day despite fevers, aches, and a pounding headache.
So, in the absence of time to get well, Americans seek antibiotics and because doctors can imagine being in our shoes, they freely prescribe them.
And, btw, I am lucky. I had sick leave to use. There are so many Americans without sick leave time.
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@Kelly So true.
3
@Kelly : Your co-workers are lucky too. You spared them from being exposed to your viral infection.
6
couldn’t get through this without a some big eye rolls at all the practitioners this patient saw who gave nearly 0 effort in discovering her ailment (until her final doctor, of course). three courses of antibiotics is inane given how unhelpful the previous courses had been. my experience with practitioners nowadays is they just throw some antibiotics at the issue - there’s a real lack of care, attention, and ability here.
and on top of this, given all the news about drug resistant bacteria we’ve been hearing about! seems incredibly irresponsible and poor medical advice.
if you can, find a functional medicine doctor.
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@sca--And yet, no one ever figured out what was wrong in the first place. The final diagnosis was of symptoms caused by the third antibiotic.
A very strange case.
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@sca The problem is our assembly-line medical system. Doctors are forced to see many patients a day, giving them only 10 or 15 minutes each. Of course they try to find the quickest solution. Sometimes a drug like a steroid that relieves the symptoms so that the body can heal itself is the best choice.
I've had sinus problems all my life, and I remember ENT specialists from my youth who treated symptoms in practical ways, such as stuffing patients' noses with cotton soaked in a pungent solution and then putting them under a heat lamp for 20 minutes. That actually helped. They now seem to offer surgery as the only option. I'm sure it's more lucrative for the doctor, but it's very painful and debilitating for the patient.
10
@Susan Dean
Reducing turbinates, an in-office procedure by my ENT, a brief stint of steroids, and regular use of a saline nasal wash finally solved my sinus
problems.
1
Bactrim is NOT standard of care for sinusitis treatment. I am very surprised that it was prescribed by an ENT.
36
@Convince Me
It can be. I have a primary immunodeficiency not treated by immunoglobulin and juggle 3 to 4 antibiotics that kill the bacteria to sinus infections, which I am very susceptible to.
4
@Sadie Smith @convince me You are both correct. Bactrim (a sulfa drug) is not a typical first line antibiotic for sinus infections, but patients with recurrent infections may need to "rotate" antibiotics. Bactrim, however, will work for simple bacterial sinusitis, especially if this is a first time infection.
1
@Convince Me
The last time I saw an ENT, I ended up in the ER. He asked me to let him do a biopsy in his office without waiting for an ultrasound "because he didn't need it." I did not give informed consent, because I was not informed of the likely consequences. My throat became swollen, and filled with fluid as a result of his bungling. When the ultrasound biopsy was done, it took a staff of 6 and the radiologist had a difficult time even while using ultrasound to guide him. He did an outstanding job and strict surgical procedures were adhered to. However, the ENT did not ask me if I had taken aspirin, only swabbed a little betadine on my throat and did not even wash his hands. So I am not impressed with an ENT specialty.
1
While I've overall been healthy my entire 56 years, and rarely 'very sick', when I think of those times I did feel really, really sick...like I just wanted to 'die', both times it was due to strong meds.
The first time, after debilitating neck tension and pain (from long-term work stress that finally affected me physically...), a doc prescribed..I think it was percocet. I took just HALF a pill, and felt so sick at work that... I couldn't even fathom making it home (and where I live alone), and instead contacted a nearby friend to ask if I could spend the night at her place. That's how sick I got from the med (which I naturally stopped taking...)
Another time, I got a bad infection from a biopsy that was not done properly. When one antibiotic didn't work, nor a second, the third antibiotic I was put on was a form of a sulfa med. After all these antibiotics over a few weeks time, and the most recent being the sulfa... after maybe 5 days on the sulfa, I was feeling worse and worse, and finally broke out in hives. I called my insurance co's 24/7 nurse line, and was told to immediately stop the meds. Turns out, I apparently have an allergy to sulfa meds. That was the second time that I felt like I 'wanted to die'... because of how the meds made me feel.
33
@Lynn First, if you never received a sulfa medication before, you wouldnt know if you were allergic to it. In fact, you might only discover that on the second time exposed to the medication. Second, without knowing what you were given before, I cannot comment on the plusses or minuses of what you received. However, IF you had any purulent drainage, your doctor should have gotten a culture, so they would know what antibiotic would work in your case.
Drugs create complications. I had one acquaintance who had an illness that required hospitalization and ultimately was given morphine. She began to decline and nearly died going into a shallow coma. Turns out she was very allergic to morphine. She couldn't tell anyone she felt awful on it because of it's effects, so they just kept giving it to her until someone decided to stop it- she doesn't know who. And then she got better.
43
Myocarditis?
2
I'm a geriatrician. The problem here is the desire of the doc to "do something" for the patient even though he/she doesn't really know what's wrong with her. Medical treatments have risks.
A good principle if that if you don't know what to do, don't do anything. Or as I like to say: Don't just do something. Stand there!
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@alan lazaroff Suggest you incorporate botanical medicines and dietary changes into your protocols, as well as minimum 4 days "bed rest". Side effects ? Recovered health.
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@alan lazaroff
Sage advice. I learned it in NY from a colleague who got it in his training in SC.
@alan lazaroff
I want you for my doctor! Thank you for practicing.
2
As one ages and slowly picks up allergies to one antibiotic after another, the choices of an antibiotic for a doctor and patient for any issue caused by bacteria get more and more limited.
This is one problem that electronic records should assist medical staff in knowing about and avoiding. Since out of net work ERs are rarely informed about a patient's history in the detail which is in the history of in-network doctors (and often available only to medical staff owned by a hospital group with ambitions to roll out a Medical Plan) the limited information can lead to serious problems. Deciding who can have access to one's medical records is upsetting to many patients when they are very ill. I have listened to people older than I am refuse to name close relatives as people who can be given information as bland as which hospital and a general diagnosis because they don't want people to worry. In that frame of mind, giving permission to an unknown infectious disease specialist is unlikely to happen.
10
Knee jerk antibiotic prescriptions are still a problem perhaps? I've always been curious about the so-called "minute clinics" inside drug stores and their prescribing habits. They make their money off colds and flu and the convenient pharmacy right there makes money off prescriptions......hmmmmmm....
32
@BA
I remember going to urgent care, and seeing a doctor for a cold that lasted for quite a long time, and I was spitting up yellow sputum from my throat and chest. I had no fever, and he thought I had bronchitis. He then suggested prescribing an antibiotic in case it came back, which I firmly declined, as well as an inhaler (albuterol). I tried it once, got a weird feeling, and stopped using it. I used steam and a lot of water, as well as the extra-strength 12-hour Mucinex, all of which worked.
4
Bactrim/sulfa drugs are notorious for causing these types of reactions. Both my son and I have had reactions including not only a rash, but very bad muscle aches and fever. In fact , his was so bad that we thought it was sepsis from the skin infection that was being treated by the Bactrim. Thankfully, the Infectious disease specialist in the ER at the time realized what it was.
76
@Ellen O’Hara
You don't need a specialist to diagnose a rash secondary to Bactrim sensitivity. We run of the mill clinicians do it all the time.
24
@Ellen O’Hara
My 12 year old son was hospitalized for high fever, severe headache and weakness after a bactrim prescription for an infection. The docs in emergency had no clue it was a reaction to the drug, in fact dismissed that as a possibility when I brought it up because of my own and my other son's allergy to sulfa. When he later had surgery in a children's hospital, the nurses advised that it was definitely an allergic reaction. My point is, its hit or miss if the docs have a clue. It is not something that you can depend on.
2
@Convince Me
Not so. We had quite the opposite experience with er docs for my son and my own personal physician when I had a severe sulfa reaction.