Why should anyone take three weeks of antibiotics?

June 28, 2007 7:45 PM

Should I load my body with antibiotics for three weeks?

I saw an allergist today for chronic (I mean really chronic) hives, and she said I wasn't allergic to anything, but then she gave me a shot of cortizone and three months of zyrtec. She only tested me for environmental allergens, but said that my body isn't acting like it's allergic to food allergens. Then she said I also have a chronic low-grade sinus infection and prescribed THREE WEEKS of antibiotics. I am very anti-antibiotics, as my body is VERY sensitive to them. I will get a gazillion yeast infections and will probably experience some skin burn also (as in the past). I am full of dread and haven't taken an antibiotic in over two years.

I had never seen this allergist before and don't know if I trust anyone that would prescribe such a heavy dosage of antibiotics. I feel pretty ok (except for the hives every day), do not feel sick, and am healthy enough to have ridden 60 miles on my bike on Saturday, so how can I possible need 400 mg of Avelox every day for the next 21 days?

Should I see another doctor? Don't bother with all the disclaimers. I assume you're not a doctor and am probably going to go see a different doctor anyway. Just curious about personal experiences.

posted by bash to health (29 comments total)

Your stomach will never forgive you for taking that regimen if it's unnecessary.
posted by IronLizard at 7:50 PM on June 28, 2007

"Chronic infection" generally means it's not going to go away on its own. You have hives and a sinus infection, you should expect to take something for them.

To keep from getting something like a yeast infection, try lactobaccilli in tablet form as a supplement, which is usually available over the counter in pharmacies (but you have to ask for it because it is refrigerated). Stay off of refined sugars as much as you can. Yogurt is also helpful.

You can't be feeling that great if you have both a chronic sinus infection and recurring hives and went to the doctor.

Also, is there a reason why you are against antibiotics? And you do realize that you need to take a complete course of antibiotics for them to be effective, right?
posted by misha at 8:04 PM on June 28, 2007

I went to the doctor because of the hives, not for anything else. I am against a three week course of antibiotics because of the reasons I mentioned in my original post, and because I know it will completely destroy all the wonderful intestinal flora I have. My body is very sensitive to medicines. I don't know why. I usually just feel worse in different ways when I have to take antibiotics.
posted by bash at 8:19 PM on June 28, 2007

A basic course of antibiotics seems to be 10 days, but might not completely get rid of a chronic sinus infection. So you take the basic course, get a yeast infection, get over that, and your sinus infection is back. More antibiotics, more yeast, altogether miserable. I'd rather take the 21 days.

If antibiotics=yeast for you, talk to your doctor about your concerns. Perhaps a solution like taking Diflucan prophylactically will work.
posted by rossmik at 8:21 PM on June 28, 2007

Did you ask the doctor about the antibiotics, your previous experience with them, and if there are any other alternatives? If you were my patient I'd want to know that you're hesitant to take them, as it will influence my management.

(Your antibiotic sunburn is almost definitely only with tetracycline antibiotics -- doxycycline is the most common one -- this is a side effect of the tetracyclines but not others; Avelox is not a tetracycline.)
posted by gramcracker at 8:21 PM on June 28, 2007

I did tell my doctor that I am very uncomfortable taking antibiotics, but she actually said I would have to "hunker down" and get through it. It's just that I've never seen this particular doctor before today, and I am not one to instantly trust a person in a white coat.

She gave me three doses of Diflucan (one for every week of the antibiotics), but it really does make me uneasy to have to load myself up like this. As I said before, she also gave me zyrtec and a shot of cortizone, and (i forgot to mention) some sort of nasonex type thing. I forget the brand.

It kind of freaks me out when doctors just load you up with stuff after spending 30 minutes with you. I'm not anti-medicine, I'm just anti-unnecessary medicines.
posted by bash at 8:29 PM on June 28, 2007

Three weeks is not an abnormal length for an antibiotic prescription; I've definitely had 3 week courses of antibiotics before. Of course I'm not trying to dismiss your sensitivities, but this might be what it takes to get rid of your sinus thing, you know?

If you haven't already told your doctor about your concerns, ask if maybe there's another antibiotic that would be equally effective and has a shorter duration; not all antibiotics are created equal, but there are usually a couple of alternatives to any given one.

About the yeast infections: oh, misha already suggested yogurt. That's what I was gonna say.
posted by rkent at 8:30 PM on June 28, 2007

How long do you think it should take to clear a sinus infection with antibiotics?
posted by ikkyu2 at 8:36 PM on June 28, 2007

I guess it's really a personal decision -- are the hives really bothering you? Apparently this is a possible treatment. I guess it's up to you whether you think the treatment is worse than just dealing with the hives. (I don't pretend to understand the hives/sinus-infection relationship, but that's why I'm here on AskMe, instead of wearing a white coat and sleeping soundly on a giant pile of money insurance bills.)

Can't really give you any input to that decision, because none of us really know how bad the hives were (although, I'm assuming they were pretty bad if they made you go see a MD in the first place).

Only point I will make is if you decide to "hunker down" and take the antibiots, once you make the commitment to do it, don't bail out halfway. Once you're in, you're in for the course.
posted by Kadin2048 at 8:38 PM on June 28, 2007

If you don't want to take the antibiotics for the full prescribed period, don't take them at all. Uber-antibiotic resistant diseases breed when people don't complete their antibiotic cycles. If you do decide to take the antibiotics, eating lots of yogurt with acidophilus and other active cultures can help.
posted by croutonsupafreak at 8:41 PM on June 28, 2007

I dunno, 3 weeks of antibiotics to make a chronic infection go away seems reasonable to me. Or you can live with the infection for heaven knows how long.

Certainly seeing another dr seems like a good idea, if for no other reason then to put a plan together to help mitigate the effects of the medication. Perhaps you could also work with a dietician to create an eating plan to help with side effects and to help your beneficial bacteria return once it's all over with.

Good luck!
posted by Salmonberry at 8:47 PM on June 28, 2007

how does she know the infection is chronic if she only saw you once? i'm all for antibiotics when they're necessary, but i would get a second opinion in this case. your insurance should pay for one.
posted by thinkingwoman at 8:50 PM on June 28, 2007

My 6 year old son had hives off and on one day, off to the Doc we went. He felt and looked fine other than the hives. Come to find out, he had strep throat. His throat looked good and healthy, but the hives....swab was positive.
posted by JujuB at 8:59 PM on June 28, 2007

I was on an even longer course of antibiotics this year. What I found interesting was that the doctor who prescribed it to me overseas also prescribed probiotics to take with them. I had to continue on the antibiotics back in the U.S. and took them with probiotics I picked up from Whole Foods (it's in the refrigerated section). The nurse practitioner I talked to in the U.S. scoffed at the idea, but I did not experience any of the problems I had previously while taking antibiotics (yeast infections, gastric problems, you name it).
posted by needled at 9:00 PM on June 28, 2007 [1 favorite]

Just a few points that may help you make the decision:

1) 3 weeks is actually what most experts would consider a rather short course if anything for treatment of chronic sinusitis, if that is indeed what you have.

2) Chronic sinusitis is defined in part by symptoms of at least 3 months duration. That means you probably have a few days, maybe even weeks or longer, to ponder the decision and perhaps get a second opinion, without necessarily developing a complication off antibiotics. In fact, it's not even always clear that there is necessarily an infectious component to the condition.

3) Many physicians do diagnose chronic sinusitis based on history and examination, however if you are particularly concerned about the treatment and want something more definitive, there are circumstances in which certain diagnostic studies can be confirmatory. See an otolaryngologist for a second opinion, and discuss the pros and cons of sinus x-rays, CT scans, and nasal endoscopy.

4) At the very least, consider frequent irrigation of your nose with saline, perhaps twice a day. Water is generally low on side effects, and irrigation has been shown in multiple studies to have a positive impact on sinusitis symptoms, limit the need for medications, and generally serve as an effective adjunct to other measures. Unfortunately most people hate squirting water up there nose so I leave it to you.

I wish you the best of luck.
posted by drpynchon at 9:19 PM on June 28, 2007

Chronic low-grade sinus infections can be very, very difficult to get rid of (mine has been going for years now, though there are complicating factors). In my experience, the antibiotics aren't likely to help if they aren't lengthy and strong. If your infection is chronic, it is a lot less likely to go away with a light dose. Take the antibiotics, see if it helps, and if not go visit an ENT or rhinologist.
posted by ssg at 9:20 PM on June 28, 2007

My cat is on a month-long program of antibiotics (125mg Clavomex) for a chronic mouth infection, and she only weighs 3 kg.
posted by mendel at 9:24 PM on June 28, 2007

I would second everything drpynchon said in spades. Personally, if I were to inflict three weeks of abx on a patient I'd get a CT scan of their sinuses to be sure their symptoms of congestion and snot were sinusitis and not chronically purulent nasal discharge. And quinolones, i.e Avelox, Cipro, etc., are common culprits for clostridium dificile colitis. They also cause a great many persons to have mild to intense neurologic side effects. Clindamycin and other drugs are likely as effective, and cheaper [but maybe no more tolerable]. It takes balls to send a patient out to pick up a three hundred dollar round of antibiotics for a clinical syndrome that isn't proven and that they may not tolerate. As well, it seems a little incongruous to treat something as vexing as hives while simultaneously introducing a brand new drug to the system.

The key is you are unsure of the next step. At the very least you need to call back and express your concerns to your doc again. Get a second opinion from an ENT if you wish.
posted by docpops at 9:54 PM on June 28, 2007

I also have a bad reaction to antibiotics but I was on them for months when I got Lyme disease and your body adapts. Live yogurt helps.

Bonus: I was on the antibiotics as an older teen and my skin was absolutely perfect after that.
posted by fshgrl at 10:14 PM on June 28, 2007

"Chronic infection" generally means it's not going to go away on its own. You have hives and a sinus infection, you should expect to take something for them.

True, but if you ask me, the "chronic" in "chronic infection" also generally means antibiotics ain't gonna do shit in the long term, to use the medical parlance. Do you have any reason to believe this won't just resurface in a year?

As you certainly seem to know, antibiotics are the carpet bombing of medication. What else have you done to address the problem? What might the root causes be? Have you seen a dietician? A naturopath, even? Are there possibly psychosomatic causes? Have you tried saline? Have you looked in to "natural" remedies, such as oregano oil (no snark, please, anyone - I will personally attest it has worked for certain infections in the past. Of course in one I needed some amoxicillin, but that was pretty extreme bronchitis).

I, from miles away via a keyboard and screen, second your suspicion of this allergist. For what that's worth.
posted by regicide is good for you at 11:54 PM on June 28, 2007

Other people have given you good advice about handling your concerns, so I won't waste your time repeating it. I will say that no matter how you handle it, if you do take the antibiotics you need to take all of them not just take them for however long you feel is necessary. Not finishing courses of antibiotics is a very bad thing.
posted by Justinian at 12:18 AM on June 29, 2007

that's what diflucan is for
posted by matteo at 12:58 AM on June 29, 2007

Her medical advice isn't out of the ordinary. But regardless, if you're not comfortable with this doctor's attitude or approach, go see another one.
posted by desuetude at 6:22 AM on June 29, 2007

3 wks of antibiotics is definitely rough. I've had chronic, persistent, lowgrade sinus infections, it has taken that to get rid of it. The last time, I took 10 days of ABs that didn't work so then the doc gave me another 3 weeks. it stunk. literally. biaxin smells BAD. Also, when you're taking ABs for that long, you may want to take some supplements to keep the bacteria in your body at good levels. I see you're a lady. take acidophilus, trust me on this one.
posted by Soulbee at 6:30 AM on June 29, 2007

Simply get another opinion. You need to trust your doctor, and if you don't, they won't be able to help you. Also, if the next doctor suggests antibiotics as well, explain exactly why you don't like them (you may have, but saying you're simply 'very uncomfortable' with the idea won't cover it). They're may be an alternative solution, but you're not going to get it from a doc unless they have a damn good reason for suggesting it instead.
posted by cgg at 7:22 AM on June 29, 2007

I second Justinian. Whether you take the antibiotics or not, don't take them for a very short amount of time, and then stop. Bad idea, because you expose the germies to that antibiotic and if it flares up again, the antibiotic won't be as effective for you; possibly it won't be effective at all. And on a more selfless level, it also makes the world a little less safe for immuno-suppressed people.
posted by RobotHeart at 7:47 AM on June 29, 2007

Speaking of immunosuppression, your doctor gave you a shot of cortisone, a potent immunosuppressor, so if you fail to take the antibiotics your sinus infection may get much worse. In addition to the probiotics people have suggested, I would take some Saccharomyces boulardii. According to the Merck Manual (1999; P.294):

Attempts to maintain the homeostasis of fecal flora during antibiotic therapy by using oral lactobacillus preparations have generally been inconclusive. The non-pathogenic yeast Saccharomyces boulardii (250 mg by capsule bid) was found in one study to have a protective effect. Given concurrently with antibiotics, this treatment significantly reduced the incidence of diarrhea, although isolation of C. difficle was not affected. The precise mechanism of action is not well understood, and this preparation is unavailable in the USA.

Here in 2007, I have found it to be widely available.
posted by jamjam at 11:08 AM on June 29, 2007

i'd be wary of 3 weeks of antibiotics too. i've never tried this, but maybe rinsing with a salty neti pot would help kick the sinus infection?
posted by twistofrhyme at 1:08 PM on June 29, 2007

I just wanted to say that this happens to me too. I get the sinusitis, feel sick, etc... Then the doc prescribes antibiotics and it goes away for a while and then comes back. I've tried claritin, which kind of works, but doesn't really do anything, etc.. Also, it happens fairly seasonally (beginning of June and then mid-end of October) and I've been tested for allergies and they didn't find anything. Its really frustrating!(!!).

I've found that I can figure out when its coming on if I pay attention, its kind of useful to know, but doesn't help because I can't stop it. However, this year I started taking muscinex (for a couple of days) when I've noticed it coming on and it _really_helps_. I think if I mixed in a saline nasal irrigation I would have no problems whatsoever.

So, definitely get tested for allergies. If you come back negative then I would try the muscinex/irrigation when you feel it coming on.
posted by kookywon at 1:25 PM on June 29, 2007