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Medical Forum / Diseases and Disorders / Sinusitis / January 2007

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Help! Good alternative to cipro?

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Oakfed - 17 Jan 2007 02:59 GMT
I have a severe sphenoid sinus infection that was resistant to
amoxicillin and augmentin, and was prescribed cipro. Cipro seems to be
working, but I'm having side effects (pain like wires being drawn in
various places - palms, soles of feet, knees and elbows; also mood
swings, insomnia, and weird dreams) and want to stop the cipro.
Reading the literature, it seems cipro is known to cause tendonitis or
even ruptured tendons.

My MD suggested and prescribed Avelox, another quinolone. He said it
didn't have the warning about ruptured tendons - but i've been looking
it up as well, and it does (as do all the quinolones).

So I'd like to switch to an antibiotic that's got similar coverage to
cipro, but isn't a quinolone.

Does anyone know of a good alternative?

Alternately, has anyone ever had these side effects with cipro and
have them not be serious? I haven't actually got tendonitis yet, but
the pains seem like the precursor, and I'm hesitant to take chances -
but I'm also desperate to get rid of this sinus infection.

As an aside, the tendonitis side-effect is supposedly more likely with
people taking a corticosteriod (and I'm taking a steroid spray, like
many sinusitis sufferers). One anecdotal and not even definite
experience doesn't prove anything, but if the sprays do have some
systemic absorption, that might be a factor in my adverse reaction to
cipro.
kathywb2001@yahoo.com - 17 Jan 2007 05:06 GMT
> Does anyone know of a good alternative?

A lot of people may not agree with me, but I've had fairly good results
with doxycycline, but at doses of 100 mg. 2X a day.  It has good CNS
penetration, and with a sphenoid sinusitis you want to make sure that
you are protecting your brain from an abscess.  This happened to me
when I had a sphenoid sinusitis that wasn't properly treated several
years ago and has now led to an infection in the bone and I"m getting
ready to go on IV antibitoics for the 2nd time in 2 years.  You don't
want to end up like this.  So check with your doctor and ask for
something that has good absorption.  Sometimes surgery is necessary for
a sphenoid infection especially if the ostia are clogged up;  they may
need to be opened.   I'm not trying to scare you, but a sphenoid
sinusitis is serious.

Kathyw
Oakfed - 17 Jan 2007 07:01 GMT
Aside: Something I found on the American Academy of Otolaryngology re
systemic effects of nasal steroids and cipro:

Geriatric Polypharmacy in Otolaryngology Chapter 8, pp156
http://www.entlink.net/education/upload/Chapter_8.pdf

"The quinolone group of antibiotics is known to possibly cause
arthropathy. Corticosteroids increase the risk of tendon rupture and
or tendonitis... It should be kept in mind that the interactions may
be generated by topical nasal corticosteroids as well as oral IV and
IM steroids. The prescribing practitioner is therefore urged to keep
this interaction in mind and use this combination of drugs only when
other combinations are not applicable."
Shirley ann - 17 Jan 2007 12:25 GMT
I finally had to take Biaxin XL when Cipro did not clear my infection
up.

shirleyann
Steven L. - 17 Jan 2007 17:06 GMT
>> Does anyone know of a good alternative?
>>
> A lot of people may not agree with me, but I've had fairly good results
> with doxycycline, but at doses of 100 mg. 2X a day.  

I'm not going to disagree with you about that.

I'm going to disagree with you that it has comparable coverage to the
quinolones.  It doesn't.  Too many strains of bugs have become resistant
to the tetracycline class in recent years, due to tetracyclines being
overprescribed (just like what happened with penicillins).

Doxycycline is definitely a significant step down from quinolones.

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kathywb2001@yahoo.com - 18 Jan 2007 03:43 GMT
> Doxycycline is definitely a significant step down from quinolones.

I'm not going to argue with you on this one, but it is my understanding
that SOME of the older antibiotics are becoming more useful now because
they haven't been used in a while and many of the resistant bacteria
have been erradicated by the newer drugs which are now showing signs of
bacterial resistance themselves.  I think it is getting more common
with the quinolones too especially
Cipro.   Doxycycline may not be the best choice at all.  I'm just
sharing my experience.   I actually got worse on cipro after taking it
and other quinolones for several years and at least had marginal
success with doxycycline.  Unfortunately, I'm having to resort to IV
antibitoics again now because the infection is in the bone.

I'm sure Biaxin and the others mentioned here are OK also, but I think
I would avoid Ketek until there is more information about the possible
serious side effects on the liver.  

Kathyw
Steven L. - 17 Jan 2007 17:24 GMT
> I have a severe sphenoid sinus infection that was resistant to
> amoxicillin and augmentin, and was prescribed cipro. Cipro seems to be
> working, but I'm having side effects (pain like wires being drawn in
> various places - palms, soles of feet, knees and elbows; also mood
> swings, insomnia, and weird dreams) and want to stop the cipro.

Ah.  Besides the pains, you're experiencing overstimulation.  In some
people, Cipro works like a stimulant--you can get wired on it just like
drinking coffee.  Even worse, Cipro has recently been found to increase
the half-life of caffeine (!!!).  So if you drink coffee with Cipro, the
caffeine will last in your body much longer and you'll have trouble
falling asleep at night.  Basically, Cipro and caffeine don't mix.  I
have found that if I stop all other stimulants (coffee, tea, chocolate,
decongestants, etc.), and take the Cipro first thing in the morning (so
it wears off by nighttime), it works much better.  Are you on any other
mood-altering drugs like caffeine, nicotine, decongestants, etc.?

If not, then the next best alternative to the quinolones may be Ketek
(telithromycin).  It's probably a bit better than Biaxin.  It's got some
serious side effects too (liver failure), but fortunately that's very rare.

HOWEVER:  Let me stress that as you can see, depending on antibiotics to
get rid of sinus infections can be risky (as well as virtually
guaranteeing eventual bacterial resistance).  Once you're past this
sinus infection, you must aggressively investigate the causes of your
sinus trouble, so you don't get as many sinus infections in the future.

I fell into the habit of just depending on antibiotics to just "snap me
out of" sinus infections every time I got one, and I will regret that
the rest of my life.  (I ended up with antibiotic-resistant chronic
sinusitis.)

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Oakfed - 17 Jan 2007 18:52 GMT
>Are you on any other mood-altering drugs like caffeine, nicotine,
> decongestants, etc.?

The pharmacist told me to avoid caffeine, so I haven't been drinking
any caffeinated drinks. I might have taken two decongestant/ibuprofen
tablets during the first two days - these too have contraindications
for cipro.

>If not, then the next best alternative to the quinolones may be Ketek
>(telithromycin).  It's probably a bit better than Biaxin.  It's got some
>serious side effects too (liver failure), but fortunately that's very rare.

Last night the cipro started to fail as well (4th night/5th morning).
I'm getting an infected feeling and significant welling again at the
base of the sphenoid. This is what happened with the augmentin, too
(after 5 days, alternating periods of the infection getting
worse/better, getting worse each time).

Will see what my GP suggests - biaxin or ketek sound like
possibilities.

The American Otalaryngolist Association suggests a few others -
Metronidazole plus either cefpodoxime (Vantin) or cefdinir (Omnice.
Would they also have a chance of working?

>HOWEVER:  Let me stress that as you can see, depending on antibiotics to
>get rid of sinus infections can be risky (as well as virtually
>guaranteeing eventual bacterial resistance).  Once you're past this
>sinus infection, you must aggressively investigate the causes of your
>sinus trouble, so you don't get as many sinus infections in the future.

I haven't had many sinus infections  - 1 infection in ~1993, 1 in
2004, 1 in 2005, and the current one - or taken antibiotics for any
other illness since childhood.

I had chronic sinusitis after the 2005 infection; two antibiotics
seemed to work but relapsed. Since then, I've been to an allergist and
two ENTs and tried to follow good sinusitis regimen - daily saline
rinses, and I tried papaya and NAC.

(I posted a few months ago about my papaya experience - it seemed like
it was helping, but in retrospect I think the symptoms I was feeling
(like parts of the sinuses were sticking and unsticking) were actually
symptoms of inflammation or swelling in the sphenoid, either a
low-grade infection or else some effect of the papaya enzyme.

My ENT had originally scheduled me for surgery, but seemed convinced
all my problems were ethmoid/maxillary related, since thickening there
was visible on a CT scan, despite my symptoms being sphenoid ones. He
was quite dismissive when I asked if there could be problems not shown
on the scan. I was worried that the surgery was going to be useless,
which is why I tried papaya while waiting for the surgery to be
scheduled.

I had two exams after the papaya seemed to be helping, and then in
November the ENT said I didn't need surgery or to consult hi mm any
more, and to just keep doing saline rinses and steroid sprays.

I thought that a bad sphenoid infection had to be treated, though? My
symptoms were pretty bad - grotesque-feeling swelling throughout the
entire sphenoid, pressing down behind the throat, along with fever and
chills.
Steven L. - 18 Jan 2007 03:31 GMT
> The American Otalaryngolist Association suggests a few others -
> Metronidazole plus either cefpodoxime (Vantin) or cefdinir (Omnice.
> Would they also have a chance of working?

IIRC, Vantin has almost exactly the same coverage as Amoxicillin.  If
Amoxicillin didn't work, Vantin won't either.  Ceftin and Omnicef have a
somewhat different coverage, but still not as extensive as the
quinolones.  You can try Omnicef or Flagyl, but it's starting to look
like what you have isn't responsive to antibiotics.

The symptoms you're experiencing--the antibiotic seems to help and then
the infection roars back even before you finish the course of
antibiotic--suggest that there is a physical blockage in a sinus that is
preventing it from draining.

Have you asked your physician to prescribe a course of oral steroids,
such as Medrol?  It might help reduce the swelling and inflammation
inside your sinuses to the point that the antibiotics might do a better job.

> I thought that a bad sphenoid infection had to be treated, though? My
> symptoms were pretty bad - grotesque-feeling swelling throughout the
> entire sphenoid, pressing down behind the throat, along with fever and
> chills.

I suggest you get a second opinion from another ENT.  You'll definitely
need to get another CT scan and another nasal endoscopy, to see what's
happened to your sinuses recently.

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Oakfed - 18 Jan 2007 05:03 GMT
>I suggest you get a second opinion from another ENT.  You'll definitely
>need to get another CT scan and another nasal endoscopy, to see what's
>happened to your sinuses recently.

I've booked with my original ENT but not for a week and don't have a
referral to another; will ask my GP. Am now worried because waiting
line for my last CT scan was a couple months - waiting lines for many
kinds of surgeries/diagnostic procedures are a fact of life here in
Canada. I definitely can't go another couple months like this.  Also,
worried about steroids - I've taken them before, but steroids are
supposedly a big no-no for people with quinolone toxicity.

GP considered doxycycline but rejected it because I already have some
stomach upset and mild diarrhea, and decided to try sulfatrim. I've
had it before, in 2005 - it was the first one i had, and it worked,
but I got a cold a couple days afterward and my sinus blew up again.
We'll see what happens. Right now (several hours afer one dose in of
sulfatrim) I'm not sure it's having an effect and things are still
getting slowly worse (but haven't reached as bad a point as they were
before).

If anyone else has a bad cipro reaction, they may want to check out
the info at http://fqresearch.org/ and
http://www.fluoroquinolones.org/ and the Yahoo forum
http://health.groups.yahoo.com/group/quinolones/.
Steven L. - 18 Jan 2007 17:56 GMT
> GP considered doxycycline but rejected it because I already have some
> stomach upset and mild diarrhea, and decided to try sulfatrim. I've
[quoted text clipped - 4 lines]
> getting slowly worse (but haven't reached as bad a point as they were
> before).

No antibiotic can take effect that quickly.

Because the blood supply to the sinuses is relatively poor, it can take
at least 4 days for enough antibiotic to get in there.

Give it a full 5 days to see if you've experienced significant
improvement.  If not, then it hasn't worked.

As for the stomach upset and mild diarrhea, acidophilus supplements can
repopulate the bowel and are a good thing to take whenever you're on any
antibiotic.

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Oakfed - 18 Jan 2007 21:56 GMT
>No antibiotic can take effect that quickly.

They seem to take effect in 2 days for me. Not full effect, but enough
to know they're working.

With the initial infection, I felt what I thought was improvement from
the augmentin starting within a couple hours - I could feel the huge
swelling being pulled at, pulled in. Maybe that was just change in
blood flow or something. But when I woke up the next morning, the
really bad cone-like swelling down into my throat was gone, and on the
morning of  the third day my sinuses felt open, though still a little
raw and thick/inflamed around the edges.  Cipro acted this fast as
well, while I was taking it - it seemed to 'fix' things really  early
on the third morning.

But I'm taking this until my ENT appointment Tuesday, anyhow.

Has anyone else here had a quinolone reaction? Doctor thinks mine will
go away by Monday and pooh-poohed the quinolone support group info I
found, but I'm unsure and worried who is right.

I had the worst night last night - burning and pain in both arms, both
legs, both hands, both feet, and across the back. It was like red-hot
cables had replaced all my tendons. I think I got maybe an hour of
sleep. Today I just seem sore in all those affected places, and
everything aches after exertion. Hope tonight isn't like last night.
kathywb2001@yahoo.com - 20 Jan 2007 04:00 GMT
> I had the worst night last night - burning and pain in both arms, both
> legs, both hands, both feet, and across the back. It was like red-hot
> cables had replaced all my tendons. I think I got maybe an hour of
> sleep. Today I just seem sore in all those affected places, and
> everything aches after exertion. Hope tonight isn't like last night.

It sounds to me like you are having a bad reaction to the cipro,
although I have
gotten the same kinds of pains just from the infection.  I don't think
I would
continue to take it.  The tendon ruptures are rare, but they are real.
Another
rare side effect is heart irregularities that can be fatal.  Again
these are rare,
but with your symptoms, I wouldn't take the chance.  Can you not go to
a walk in clinic over the weekend and ask for something else? Another
option might be clindamycin (it could be an anaerobic infection)  Also,

waiting for 2 months to get  a sphenoid sinustis properly treated seems
ridiculous, although I've been there too, acutally years, but suffered
probably irreversible consequences from it.  If you are sure this is a
sphenoid sinusitis, you need to get it treated ASAP.  Can you get
treatment outside of Canada?   Do you live anywhere near Buffalo,
NY?  Dr. David Sherris properly diganosed my sphenoid sinusitis and did

surgery to open up the otia and allow better drainage.  I do think it
has helped
but like I said I still have the issue with the bone infection in the
ethmoids and
maxillaries and the chronic inflammation that probably will never go
away.  

Kathyw
Oakfed - 20 Jan 2007 17:45 GMT
>It sounds to me like you are having a bad reaction to the cipro,

Definitely. The last couple nights have been only a little better.
Also have tinnitus, dry mouth/nose, joint aches. I stopped the cipro;
started on the replacement antibiotic but the GP said I should stop
that too when my reaction got worse (the night I mentioned) so now I'm
taking nothing, waiting for the ENT appointment. I pestered the GP
repeatedly for referral to someone who knows anything about cipro
reactions, to no avail - he said the ENT was the best bet since he'd
have had more experience with these antibiotics. Local clinic was
totally dismissive of the symptoms and said they'd pass in a few days
- I'm not so convinced, especially from what seems credible info at
http://www.fluoroquinolones.org/. Pestered the ENT office as well for
an earlier visit but they said all they can do is book me in Monday if
there's a cancellation. Tried for referral to another ENT earlier from
GP and my ENT to no avail. Feeling a little annoyed by the lack of
help so far.

> If you are sure this is a sphenoid sinusitis, you need to get it
> treated ASAP.  

I'm very sure - it's pretty obvious to me now, anyhow. But since it
seems my problems have been sphenoid all along, it's been two years
already.  :-(

No other sinuses will give you swelling behind the throat - which is
what I had with this current bad infection which started late
December. It was an awful feeling, like my tongue was in the middle of
it all (it wasn't of course, it just felt like it).

> Can you get treatment outside of Canada?  Do you live anywhere
> near Buffalo, NY?  

I'm on the other side of the country, unfortunately. (Victoria, BC). I
don't know how long surgical wait times are, they're triaged. Some
surgeries deemed non-critical (hip replacements, frex) have long wait
times, ~6 months. Maybe the CT wait times are triaged too. I hope so.
I'll find out at the ENT appointment, I guess.

But waiting for it over this weekend is annoying. Sinus infection is
still getting worse, but at least it's doing so slowly and hasn't
gotten as bad as it was initially.

Suppose I could try Seattle/Portland area though in extremis - anyone
know good ENTs there who are experienced with sphenoid surgeries?
kathywb2001@yahoo.com - 20 Jan 2007 19:34 GMT
> Suppose I could try Seattle/Portland area though in extremis - anyone
> know good ENTs there who are experienced with sphenoid surgeries?

I don't know of anyone in that area.  Just make sure that you find an
experienced
ENT to do this kind of surgery.  It can be very dangerous if not done
by a competent
ENT.  You may just need the openings widened to allow for better
drainage, but you
need to get on another antibiotic as soon as you can to keep this from
spreading to
your brain (again this is a rare complication, but better to be safe
than sorry)

Good luck!!

Kathyw
Oakfed - 24 Jan 2007 03:14 GMT
Visited the ENT today. He scoped me (but didn't order a CT scan; I do
have a recent X-Ray that's negative) and decided my symptoms didn't
indicate a sinus infection - noticed some mucus (I've been getting a
little mucus and soreness in the cheeks/forehead for a bit while all
the worse stuff was going on). Asked for a followup in two months
(call if things get worse).

So what the hell have I got?

My symptoms are a feeling of swollen tissue everywhere across the
forehead, top and back of the head, and behind my ears. There's a sort
of tension and irritation, and a rumbling sound in my ears. Twice in
the last couple weeks, this has blown up into really alarming symptoms
- once a grotesque swelling feeling like a hollow cone projecting down
in to the neck, and once a weird feeling like a hair net all over the
back and top of my head, filled with swollen stuff like a balloon.
Both times, it started 'acting up' to get there, characterized by a
feeling like a wind in my head and lots of stuff moving around,
eventually filling in everything. This was preceded by weird feelings
of cables of various types - some very tight like piano wires, some
spongy, some more like ribbons with rough edges - across the back of
my head. They move, but seem very specifically located (unlike the
vague pressure and fuzziness in the top/back of the head, increasing
to uncomfortable levels when lieing down, which were the main symptoms
of my chronic sinusitis) - I can feel them getting tangled in one
another as they cross when they do so. Both 'crises' were preceded by
the feeling of increasing numbers of these cables, and eventually
everything sort of pulled together until I felt no empty space at all
and started the swelling  - I could feel the cables getting all
tangled up in swollen tissue as it happened, and hear the creaking as
it pushed into various areas.

I don't have a fever, anyhow.

Can a stress reaction give symptoms like this? That was suggested by a
clinic doctor I asked for advice, and I have been stressed lately. It
would certainly be a more welcome diagnosis, if true, than a sphenoid
infection.

The other weird thing is that this seemed to all begin when I started
taking papaya tablets. That's when I started feeling weird symptoms
that I took for improvement (like tissue unsticking and sticking, in a
track that eventually led from above my nose up, over the top and then
across the back of the head). That was in August - stress reactions
don't take place over 5 months, do they?

Any ideas?

Cipro-ADR-seeming symptoms (mostly burning/achiness in hands, feet,
arms and legs, much worse in the night; dryness in mouth/nose/eyes;
feet get numb when elevated or wearing shoes, random brief
joint/muscle pains everywhere) have lowered in intensity but still
persist, and the 16th was my last dose. But this sinus/swelling
problem happened before (and was what I was prescribed cipro for).
kathywb2001@yahoo.com - 24 Jan 2007 06:17 GMT
> My symptoms are a feeling of swollen tissue everywhere across the
> forehead, top and back of the head, and behind my ears. There's a sort
[quoted text clipped - 20 lines]
>
> I don't have a fever, anyhow.

This all sounds like something from a science fiction novel, but
believe me, I know how you feel.  I really don't think this is stress
related.  A sphenoid sinusitis can cause really weird symptoms that are
hard to describe.   If it isn't, then you need an MRI of your head to
see if anything else is going on.  Sphenoid sinusitis is very difficult
to diagnose, especially if it is chronic.  I just don't think most ENTS
even consider it since it is rare;  the areas of your head where you
have the symptoms are the areas where I also have had strange symptoms
over the years in addtion to the pain behind my nose, which has turned
out to be osteomyelitis.  As I have already said,  I did have
radiological evidence of sphenoid sinusitis over 10 years ago and
possibly a brain abscess (radiological evidence of area of tissue loss
on the same side as the sphenoid sinsuitis).  Even though an allergist
that I saw at Mayo at the time thought it was significant, it has taken
me 10 years and seeing several ENTS to get one to diagnose it and take
seriously enough to treat.

This is just my opinion, of course, but I would pursue this further.  I
really don't know anything else to tell you or any more advice than
I've already given, since it took me so long to get someone to diagnose
it correctly.  I have been sick all of this time, and you wouldn't
believe some of the things that ENTs have said to me over the years.  I
finally got so sick I had to quit my job and was willing to go ANYWHERE
to get help.  I have even been suicidal at times because the pain had
gotten so bad, but still nobody locally would believe me or just said
it was migraines.

My PCP that I had for over 15 years even "fired" me because he got
tired of dealing with this, even though he had diagnosed sinusitis many
times over those 15 years.   I've had 2 since then and not got a lot of
support from them either.

I'm totally frustrated with the medical profession today.  It seems
that if there isn't an easy fix, many don't want to take the time to
help.  If they can't diagnose and treat in the 10/15 minute time slot,
then you might as well forget getting help.  I also think that chronic
sinusitis is the most misunderstood chronic illness that there is.
There are so many things that can cause it and treating it is not
lucartive to ENTs unless they see a direct need for surgery.  They get
much more money for doing cosmetic surgery, that I think that most just
don't want to be bothered with something they have to spend a lot of
time dealing with.  At least this has been my experience.   I'm sorry
for the ranting, but I understand your frustration.

I hope you can find a solution.

Kathyw

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