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Medical Forum / Diseases and Disorders / Sinusitis / July 2007Maxillary Opacity
A recent CT showed left side opacity of half my sinus cavity. The ENT used a suction catheter and collected what tested as Pseudo Aureginosa. I was prescribed Cipro for 10 weeks. A new CT showed no change. Any thoughts as how to get rid of this bug? BTW one poster, Judy says she uses vinegar in saline, as bi-carb in saline aggravates my sinuses I gave vinegar a go, much calmer sinuses! On Jul 22, 4:57 pm, rockets...@talktalk.net wrote: > A recent CT showed left side opacity of half my sinus cavity. The ENT > used a suction catheter and collected what tested as Pseudo > Aureginosa. I was prescribed Cipro for 10 weeks. A new CT showed no > change. Any thoughts as how to get rid of this bug? BTW one poster, > Judy says she uses vinegar in saline, as bi-carb in saline aggravates > my sinuses I gave vinegar a go, much calmer sinuses! Pseudomondas is also killed by sodium nitrate and (you are going to love this) gunpowder. Azithromycian (Zithromax, a macrolide antibotic) talks it in lactone and tells it to cut goo production. > On Jul 22, 4:57 pm, rockets...@talktalk.net wrote: > [quoted text clipped - 4 lines] > > Judy says she uses vinegar in saline, as bi-carb in saline aggravates > > my sinuses I gave vinegar a go, much calmer sinuses! Pseudomondas is also killed topically by sodium nitrate and (you are going to love this) gunpowder. Azithromycian (Zithromax, a macrolide antibotic) talks it in lactone and tells it to cut goo production. If you will look it up below, you will see that once it forms a biofilm only enrofloxacin of the antibotics tested in this study kills it outright. Enrofloxian IS Cipro so your ENT got this one right. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=226988 >> A recent CT showed left side opacity of half my sinus cavity. The ENT >> used a suction catheter and collected what tested as Pseudo [quoted text clipped - 4 lines] >enrofloxacin of the antibotics tested in this study kills it >outright. Enrofloxian IS Cipro so your ENT got this one right. 10 weeks is a long course of cipro or other quinolone antibiotics. I'd watch for any unusual side effects, especially if you've had cipro or another quinolone before (Avelox, Tequin, Levaquin, etc.) Joint or nerve pains, and disturbed sleep with nightmares are often early signs. Stay alert for a while - quinolones can have delayed effects too. I had a near-immediate-onset cipro reaction mid-January this year, and still haven't recovered fully (I have mild tendonitis and neuropathy still - and of the people who do have side effects, my experience seems to be relatively mild; many have very serious and permanent injuries). http://www.fluoroquinolones.org is a site collecting info from people who've had very serious reactions. No doubt that quinolones can cause a pseudo anaphylactoid reaction-- I'm assuming this was your immediate onset cipro reaction--they can cause histamine release even in patients who never took them before. They are also hard on tendons, and can cause blood sugar variations. And, they have CNS side effects: it can vary from bad dreams to flagrant delirium. Also, some have had a bad history of skin reactions and liver toxicity. That said: they are the only oral medications that touch pseudomonas directly--they are wonderfully effective in resistant infections, especially with gram negative organisms. So, don't use them first line, but they are first line for pseudomonas. If we drive them off the market by litigation, we've lost our oral medications for gram negative infections. And they achieve as high blood levels orally as IV. They're important drugs, and must be used judiciously. Unfortunately, I believe they're sprayed on feed lots for cattle/ chicken all the time. I had a pseudomonas osteomyelitis after a surgery and was on levaquin for the better part of a year. It wasn't pleasant, but no permanent damage was done. Now, as mentioned above, I acidify my nasal wash to discourage pseudomonas (it doesn't do well in acidic environments) and I use low dose macrolides daily. Look, no drug is perfect, but if we litigate the quinilones away, we're up a creek. Judy > >> A recent CT showed left side opacity of half my sinus cavity. The ENT > >> used a suction catheter and collected what tested as Pseudo [quoted text clipped - 21 lines] > http://www.fluoroquinolones.orgis a site collecting info from people > who've had very serious reactions. > No doubt that quinolones can cause a pseudo anaphylactoid reaction-- > I'm assuming this was your immediate onset cipro reaction--they can [quoted text clipped - 6 lines] > directly--they are wonderfully effective in resistant infections, > especially with gram negative organisms. Not any more. A number of strains of Pseudomonas aeroginosa are now resistant to the quinolones. That's happening with increasing frequency. That leaves the carbapenems, which are available IV. Presumably you need an Infectious Disease Specialist when you've reached that point. In fact, Pseudomonas' ability to form biofilms makes it a tough bug to fight at all. With antibiotics or disinfectants.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > Look, no drug is perfect, but if we litigate the quinilones away, >we're up a creek. >Judy Don't know why you think I was suggesting they be litigated away? I said nothing about litigation, and the site I referenced only says this: "We do not propose to wipe out the quinolones from the pharmaceutical arsenal, but rather disclose their true properties, so that: they are only used when other less toxic alternatives are not available they are used with the minimum dosage that works and for the minimum length of time they are used the least number of times throughout a person's lifetime they are completely forbidden for treatment of animals that enter the human food chain." My particular problem doesn't seem to have been an allergy-like reaction, but rather a typical quinolone toxicity case but with very quick onset (early signs after 2 days; I stopped after 4). My initial symptoms were weird drawing pains in the hands and feet. Things were at their worst about day 5-12, and I had a recurrence at about 10 weeks, perhaps prompted by a bad URI. I've had tendonitis, especially in the feet, knee and elbow joint problems, digestive problems, anxiety, insomnia, dry skin, dry mouth, dry eyes, and neuropathy (pain, burning, and numbness mostly in hands and feet, but pretty much everywhere during the two periods I was at my worst). Most of my symptoms subsided by the 4th month, though one or two randomly pop up in cycles, and only the neuropathy is continual and persistent. I think my reaction might have been worse or even caused because I was using a steroid spray - steroids are contraindicated for quinolones. I'll certainly be more careful about reading prescription info in the future, though I'm annoyed that this was missed (all I was warned about was not to take caffeine). Anyhow, if you have to take quinolones for a long period, I'd still recommend being alert for side effects and stopping quickly if you notice them (assuming you're taking them for something non-life-threatening). Unfortunately, delayed onset of symptoms appears to be more common than the quick onset I had (so by the time you notice anything its too late - and the symptoms might not get associated with the cause, making diagnosis difficult). I know that I have said this here several times before, so for those who remember please bare with me. You need to consider the possibility that reaction that you (one) has to any antibiotic that kills gram negative bacteria is likely to depend on the degree of endotoxin the bacteria is carrying as much as the antibiotic. I have had Leviquin twice, the first time it was prescribed along with predisone, and I would worship the porciline god an hour after every dose, and I got a lot worse while taking it. I had a biofilm with a large fungal component growing worse that entire time. Later I was dismayed to find out that doxicycline, bactrim, EDTA, you name it caused the same intense impulse to study the toilet bowl. I had all these antibiotics before without even thinking about it. I was able to take Clyndiamycian (Biaxian) and Bactrium, with Sproanox, and now I think that I can take an antibiotic without getting another compulsion to study porciline up close. But remember that the strongest toxins on the PLANET, ones where the fatal dose can fit a quarter of the head of a pin, like that belonging to botulism, are produced by bacteria, actinomycetes and fungi. And when you kill them off some of them do NOT go quietly. The bugs that you are taking the antibiotic for in the first place are producing toxins to kill your immune cells that would other wise kill them, they are producing cytokins that cause your blood vessels to weep plasma and make it easier for them to attach, they produce protese that allows them to digest you, and their cytoplasm is toxic, they release this stuff when they die. So it can be tricky to kill them without having them make you deathly ill for a while in the bargain. And we are just beginning to be able to detect the presence of unculturable fastidious microbiota with a suite of toxin-producing genes, rather than just culturable bacteria. The antibiotic is only the most apparent and easily documented part of the story. Sorry I didn't read the link: there are many sites that "villify" drugs and we've lost some some drugs to a risk/benefit issue where no risk is tolerated. I do agree that quinolones can cause toxicity, but as Elizabeth pointed out, bacteria and viruses release toxins, especially as they are killed. My ENT used quinilones for a long time, and blames his tendon issues on that fact. After my year of quinolones--which were necessary to treat the bone infection--I did have a worsening of my vertigo, which was caused by viral nerve damage 30 years ago. Probably not coincidence. But other than IV antibiotics, there was no solution: I did have 2 surgeries to remove infected bone. Steven, not all pseudomonas is resistant to quinolones. Pseudomonas is a normal skin flora, it's a water loving organism that thrives in wet, dark places--hence its presence in swimmer's ear. It's why I especially don't like bulb syringes (what I was using on doctor's orders when I got my infection) and I have reservations about the tubing in water piks/grossan irrigation systems. My husband is a dentist, and all the dental journals have articles about the biofilms that exist in the tubing of the dental equipment: they use bleach to try and deal with it. I went to a lecture on resistant bacteria, and the ID expert said that new drugs for gram positives are in the pipeline, but nothing has emerged for gram negatives. That's why the topical antibiotics, acidified washes are so important. I saw a woman yesterday who acquired VRE (vancomycin resistant enterococci) in a nursing home. We looked it up: there's no way to eradicate it, and now no other health care facility will touch her-- electively. A lecture at Harvard about polyresistant organisms in hospitals recently: seriously, the ID lecturer said to burn the hospital down. Judy > > Look, no drug is perfect, but if we litigate the quinilones away, > >we're up a creek. [quoted text clipped - 44 lines] > you notice anything its too late - and the symptoms might not get > associated with the cause, making diagnosis difficult). > I saw a woman yesterday who acquired VRE (vancomycin resistant > enterococci) in a nursing home. We looked it up: there's no way to [quoted text clipped - 3 lines] > A lecture at Harvard about polyresistant organisms in hospitals > recently: seriously, the ID lecturer said to burn the hospital down. This actually came up on an episode of the ABC TV show "Lost," about a bunch of castaways marooned on an uncharted island. In it, a pregnant female castaway must give birth in the "primitive" conditions of the open air. There's no hospital. The midwife could maintain a clean field for the delivery but that's all. I pointed out to fans that by giving birth in the fresh air and bright sunshine of an uncharted tropical island that has had few if any human visitors, the mom is LESS likely to pick up a nasty post-op infection than in many hospitals. (Just as long as it's a normal birth) So for the writers to depict the birth as perfectly normal, no post-op infection, was correct. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > > I saw a woman yesterday who acquired VRE (vancomycin resistant > > enterococci) in a nursing home. We looked it up: there's no way to [quoted text clipped - 21 lines] > Email: sdlit...@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. Dr Judy. Http://www.phagetherapycenter.com. Call them. You will love this. The Dr takes samples and sends them to the Drs in Georgia (the one in the former USSR), and they find phages that attack that preticular suite of bacteria. Your patient would have to go there for the treatment. Trip and treatment cost about 7000.00 But to get rid of VRE when no other treatment exists it would probably be worth it. They also have phages that eat MRSA for breakfast. The Pentagon is setting up a unit at the hospital over there. Elizabeth > > > I saw a woman yesterday who acquired VRE (vancomycin resistant > > > enterococci) in a nursing home. We looked it up: there's no way to [quoted text clipped - 37 lines] > > Elizabeth this thread sure scared the heck out of me. should have waited to read it until after recovering from the latest doc visit. all i know is that avelox is the only thing that even dented that last infection. when i dragged myself into the pcp's office after ? weeks of being dreadfully ill he greeted me with "it's just a sinus infection, it's not going to kill you." ellen > A recent CT showed left side opacity of half my sinus cavity. The ENT > used a suction catheter and collected what tested as Pseudo > Aureginosa. I was prescribed Cipro for 10 weeks. A new CT showed no > change. Any thoughts as how to get rid of this bug? It you'll pardon my language, Pseudomonas aeroginosa is one tough son-of-a-bitch. Strains of it are not only resistant to most oral antibiotics, but it even resists dilute solutions of disinfectants you use to kill germs around your house! It can even grow on a moist bar of soap. Nasty! The only other classes of antibiotics I know of that pseudomonas is sensitive to are gentamicin and the carbapenems (such as imipenem). Gentamicin is available as a nasal irrigation solution (NOT orally). Last I checked, the carbapenem class is NOT commonly prescribed at all except for life-threatening infections. Because doctors want to keep it in reserve for life-threatening infections rather than risk pseudomonas becoming resistant to them as well. So at this point, you have two options left: 1. Consult an Infectious Disease Specialist and ask him about carbapenems. He may also know of other drugs to fight Pseudomonas that I don't know about. 2. Surgery. Medical science is gradually giving up on fighting Pseudomonas with antibiotics, if there are any other options available. The damn thing acquires resistance faster than new antibiotics can be developed. Surgery may well be your best option. Good luck. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me.
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