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Suggest Treatment For Bacterial Rhinitis
Question: I have a difficult to treat infection in my nose. I have been treated with amoxicillin three times (the first two times it worked, the third it didn't), then treated with a high dose of Augmentine Plus with bactroban (1000 mg/62.5mg) for two weeks, then it still came back. Was then given a course of flucloxacillin, which didn't work, changed to Levoflaxin for one week, which also didn't work. I was tested the day after the Levoflaxin course and the swab said I was clear of infection. I originally was diagnosed as having a staph infection in the nose, but then the ENT I saw in Spain diagnosed me as having "bacterial rhinitis" (which I didn't agree with as I had no runny nose or symptoms of rhinitis). I have only had swelling of the nostri
But I am still in extreme pain. The first ENT doctor referred me onto a neurologist who said I might have minor nerve damage from all the infections, and prescribed me Neurontin. I wasn't sure about this diagnosis so saw a different ENT specialist for a second opinion. He believes I have a staph infection that keeps on returning, and put me on a Flucidin cream for 10 days (but with no oral antibiotic). So far put the cream in for two days but no improvement. Very concerned - should the flucidin be accompanied by an oral antibiotic (such as Rifampin)? Could having a swab taken the day after finishing a course of antibiotics mean the negative reading for infection was false? Would it be safe to try another course of Augmentine Plus (as this is the last antibiotic that actually worked)
Thank you!
But I am still in extreme pain. The first ENT doctor referred me onto a neurologist who said I might have minor nerve damage from all the infections, and prescribed me Neurontin. I wasn't sure about this diagnosis so saw a different ENT specialist for a second opinion. He believes I have a staph infection that keeps on returning, and put me on a Flucidin cream for 10 days (but with no oral antibiotic). So far put the cream in for two days but no improvement. Very concerned - should the flucidin be accompanied by an oral antibiotic (such as Rifampin)? Could having a swab taken the day after finishing a course of antibiotics mean the negative reading for infection was false? Would it be safe to try another course of Augmentine Plus (as this is the last antibiotic that actually worked)
Thank you!
Brief Answer:
Detailed below...
Detailed Answer:
Hi,
I have gone through your medical history carefully and understood your concern.
1. To confirm bacterial rhinitis (nose infection), a culture of nasal secretions or swab is needed. In order to get an accurate result, antibiotics should have been stopped at least 3 to 10 days prior to culture.
I fear the test you did the day after finishing the course of antibiotics resulted false negative.
2. Commonly, the use of antibiotics of penicillin group (amoxicillin or augmentine plus) might result in resistance. If this has occurred, culture of swab is a must to determine the most sensitive antibiotics.
3. As the infection is ongoing, I'd like to have more details on your current symptoms apart swelling:
- increased nasal secretions? if yes, can you describe the color and smell?
- cough?
- pain around the sinuses (nose)?
- throat problems?
- fever?
- or any other symptom?
4. You've been taking many antibiotics of various groups. So, it is time to determine the right antibiotics. My advise is to take up to 10 days prior to repeat the swab culture again; during this time, you shouldn't be taking any antibiotic at all.
5. Sometimes, when using antibiotics, fungal infection can also develop and should evaluated and treated adequately.
6. You are reporting to have a personal history of asthma, that could be an aggravating factor and make you more prone to nasal infection.
Thank you!
Dr.Albana
Detailed below...
Detailed Answer:
Hi,
I have gone through your medical history carefully and understood your concern.
1. To confirm bacterial rhinitis (nose infection), a culture of nasal secretions or swab is needed. In order to get an accurate result, antibiotics should have been stopped at least 3 to 10 days prior to culture.
I fear the test you did the day after finishing the course of antibiotics resulted false negative.
2. Commonly, the use of antibiotics of penicillin group (amoxicillin or augmentine plus) might result in resistance. If this has occurred, culture of swab is a must to determine the most sensitive antibiotics.
3. As the infection is ongoing, I'd like to have more details on your current symptoms apart swelling:
- increased nasal secretions? if yes, can you describe the color and smell?
- cough?
- pain around the sinuses (nose)?
- throat problems?
- fever?
- or any other symptom?
4. You've been taking many antibiotics of various groups. So, it is time to determine the right antibiotics. My advise is to take up to 10 days prior to repeat the swab culture again; during this time, you shouldn't be taking any antibiotic at all.
5. Sometimes, when using antibiotics, fungal infection can also develop and should evaluated and treated adequately.
6. You are reporting to have a personal history of asthma, that could be an aggravating factor and make you more prone to nasal infection.
Thank you!
Dr.Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your advice. This is what I feared. I wasn't sure if the culture that was taken would be accurate as I had so many antibiotics leading up to the test and I think that test was taken too rapidly. The first ENT specialist didn't seem that interested in solving my problem and I felt rushed out the door. The second ENT specialist seemed more interested in listening but he also didn't give me a swab and refused to when I asked for one which I found puzzling. Maybe I will have to find a GP who will do it for me.
My concerns are that now I have started this Fucidin cream (prescribed by the second doctor), is it safe to stop it after two days of treatment? Or will I have to have the full course (the doctor recommended ten days) and -then- wait to do a swab? I started this cream last night, and have put it on 3 times today and two times last night. (recommended 3-4 times/day). Or would it be safe to stop and then wait a week to do a second swab?
My current symptoms include a slightly swollen nose, and severe pain in both nostrils and where my cheek meets my nostrils (it has slightly spread across the cheek but only about a finger's width from where my cheek meets my nostrils). I have also been using a nasal spray called Nasonex for the swelling of my nose. It has helped the swelling somewhat but not the pain. My nose when this started was EXTREMELY swollen to the point it was hard to breathe.
I have no runny nose, no discharge, no redness inside my nostrils. No fever, no throat problems. I think this is why it has been hard to diagnose.
I have had one cold during this time of the infection but I think it is unrelated because it developed way after I'd already had several infections.
I also have been told I have a deviated septum, I don't know if this aggravated the condition. I think it is more likely a staph-related infection rather than rhinitis, but it is difficult to say.
My concerns are that now I have started this Fucidin cream (prescribed by the second doctor), is it safe to stop it after two days of treatment? Or will I have to have the full course (the doctor recommended ten days) and -then- wait to do a swab? I started this cream last night, and have put it on 3 times today and two times last night. (recommended 3-4 times/day). Or would it be safe to stop and then wait a week to do a second swab?
My current symptoms include a slightly swollen nose, and severe pain in both nostrils and where my cheek meets my nostrils (it has slightly spread across the cheek but only about a finger's width from where my cheek meets my nostrils). I have also been using a nasal spray called Nasonex for the swelling of my nose. It has helped the swelling somewhat but not the pain. My nose when this started was EXTREMELY swollen to the point it was hard to breathe.
I have no runny nose, no discharge, no redness inside my nostrils. No fever, no throat problems. I think this is why it has been hard to diagnose.
I have had one cold during this time of the infection but I think it is unrelated because it developed way after I'd already had several infections.
I also have been told I have a deviated septum, I don't know if this aggravated the condition. I think it is more likely a staph-related infection rather than rhinitis, but it is difficult to say.
Brief Answer:
stop using aantibiotic meds before swab culture
Detailed Answer:
Hi back,
Thank you for providing additional data as requested.
1. Having deviated septum makes you more prone to get cold or nasal infections easily. Get a second discussion with your ENT specialist to decide whether correction of deviated septum can resolve your problems definitely.
2. With regards to swab culture, I advise to stop using any antibiotic medication (orally or locally) and wait for a week to run deep nasal swab culture.
Remember to ask for bacterial and fungal infection in order to treat it adequately.
3. For the moment, I advise to take OTC pain killers / anti inflammatory medications to ease the pain and swelling.
Can send a copy of culture results to me for further evaluation.
Hope it was of help!
Dr.Albana
stop using aantibiotic meds before swab culture
Detailed Answer:
Hi back,
Thank you for providing additional data as requested.
1. Having deviated septum makes you more prone to get cold or nasal infections easily. Get a second discussion with your ENT specialist to decide whether correction of deviated septum can resolve your problems definitely.
2. With regards to swab culture, I advise to stop using any antibiotic medication (orally or locally) and wait for a week to run deep nasal swab culture.
Remember to ask for bacterial and fungal infection in order to treat it adequately.
3. For the moment, I advise to take OTC pain killers / anti inflammatory medications to ease the pain and swelling.
Can send a copy of culture results to me for further evaluation.
Hope it was of help!
Dr.Albana
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I talked to an ENT specialist also who said that 4-5 days after finishing antibiotics should be sufficient. I am on a bit of a time limit as I am meant to leave my current location in around 10 days. I currently am a student studying for a semester in Spain but I am coming to the end of my semester, and was meant to leave Spain next Thursday.
It is Tuesday evening here, would going to get a swab done on Saturday do you think give accurate results?
He also said I can stop the Fucidin right away (in order to make way for the swab) as it is a bacteriostatic drug.
Please let me know.
Thank you for your help.
It is Tuesday evening here, would going to get a swab done on Saturday do you think give accurate results?
He also said I can stop the Fucidin right away (in order to make way for the swab) as it is a bacteriostatic drug.
Please let me know.
Thank you for your help.
Brief Answer:
This Saturday is enough time to get accurate results. ..
Detailed Answer:
Hi back,
Ok, I think this Saturday is enough time to get an accurate test.
Do not forget to stop fucidin and other oral antibiotics.
Let me know the results.
Dr.Albana
This Saturday is enough time to get accurate results. ..
Detailed Answer:
Hi back,
Ok, I think this Saturday is enough time to get an accurate test.
Do not forget to stop fucidin and other oral antibiotics.
Let me know the results.
Dr.Albana
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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