 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Sinusitis / April 2008colonized pseudomonas
My sinusitis symptoms have been pretty much the same for quite a while now. Chronic disease in L maxillary sinus but no acute disease. My lungs have not been so fortunate and I've had a mild productive cough for about 20 months now along with on and off asthma symptoms. Last 3 months I've had significant breathing problems, asthma & breathlessness, especially while sleeping and recently started using Flovent to help with this. In late June I developed a UTI and was prescribed 10 days Cipro on July 3rd. About 5 days into the Cipro my lungs started disgorging huge amounts of ugly phlegm and my lung symptoms greatly improved. I ended the Cipro on July 13th with both my sinuses and lungs doing very well. Sinusitis (chronic infection) returned to L side maxillary after 4-5 days. Coughing up phlegm continued and on July 20 I sent in a sputum sample for testing. On July 27th I was told that the sample had moderate gram positive Cocci and very high numbers of gram negative pseudomonas aeruginosa. My pulmonologist was on vacation so his PA faxed me in an RX of 10 days of Avelox. Since pseudomonas appears to be highly antibiotic resistant I decided to not start the Avelox until I could touch base with the pulmonologist and more important with my infectious disease Dr. I really need a better plan of attack for both my sinusitis and lung infection than just taking the Avelox for ten days and then relapsing after a week while creating antibiotic resistance. At a minimum I think I'll need to irrigate with an antibiotic while doing the Avelox and will probably need IV antibiotics unless I want this to remain a chronic and incurable infection. From reading the archives I've noted that several regular posters have extensive experience with pseudomonas and nebulized or irrigated antibiotics. I'd like to get input from anyone with first hand experience. I'm sure I have colononized pseudamonas in both my sinuses and now my lungs. I do not want to waste my best shot for getting rid of this pseudomonas colonization. Ideas? Suggestions? Input? btw- I have been diligent about washing my hydropulse regularly with bleach for the last year or so. Prior to this I probably was a little lax about cleaning it once a week. I am now cleaning it daily with vinegar in addition to the once a week bleach cleaning. I irrigate once daily with about 300ml of saline. thanks, AW > My sinusitis symptoms have been pretty much the same for quite a while now. > Chronic disease in L maxillary sinus but no acute disease. My lungs have not [quoted text clipped - 35 lines] > > thanks, AW Augest; Take a look here. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=226988 Once pseduo has formed a biofilm only enrofloxacin kills it. Enrofloxacin is Cipro. The quinolones interfere with the bacteria's ability to form curli and pillia and other hairlike protrusions. Unfortunately some proteins in your joints and ears are evidently simular enough for it to raise hell with them as well. All of these biofilm bacteria remain in place by latching onto cells with curli, and produce varients which are is stasis mode, which "wake up" and proliferate after the antibotic has left if the antibotic is not continued long enough the the infected cells to fall off.. http://www.biology.neu.edu/pdf/KL2007Pers.pdf Thing is I have a hypothesis that the floroquinonones like Cipro may slow your cilia production some, as well as the frumria, pilia, curli etc of the bugs, but this is just an educated guess, so I think you need something with and beyond the Cipro. The macrolide antibiotics also have an effect on psudeo, they are based on the lactones, the same base maltise cross-like chemical structure that the bugs use as messengers the way eucaryote beings like us use steroid fatty acids to communicate. The message from azrithromycian to psudeo seems to retard goo production, http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSear ch=17620382&ordinalpos=17&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel .Pubmed_RVDocSum and as Judy N. has said many times this drug is effective for her and IS pretty well tolerated, so it might be helpful for them to prescribe it along with 3 weeks of the Cipro, and continued for at least three weeks after the Cipro is discontinued to keep the residual pseudo from reforming a biofilm while your cilia time to regrow. The university of Wisconsin is presently conducting a clinical trial with long term low dose azritho for asthma. http://clinicaltrials.gov/show/NCT00266851 Under normal circumstances the epithelial tissue of your lungs and nose will slough off and be replaced over a period of three weeks or so, takes at least a tissue cycle of 3 weeks or longer to get rid of the pest, treating it for less time just invites it to come back. Also there is a drug called mucomist that breaks down the disulfide bonds in the mucus, and there is Pulmozyme that breaks down the DNA in the the biofilm. I have never had either one of these drugs, but the lab techs at the hospital mentioned using them for 3 weeks in conjunction with Cipro when I gather pretty much everyone got the flu and then a sinus infection. >My sinusitis symptoms have been pretty much the same for quite a while now. >Chronic disease in L maxillary sinus but no acute disease. My lungs have not [quoted text clipped - 35 lines] > >thanks, AW Wow, AW. I'm so sorry for what you're going through.... The others here -- surely Elizabeth, to name but one -- can give better medical direction. I'm wondering, though, if you have access to a steam bath that you could use on a regular basis. When I'm my worst, it seems to work as well as anything else to 'keep things moving,' loosening congestion and helping me to /feel/ just a bit better. I also took a quick look and saw this: Dietary n-3 fatty acids have suppressive effects on mucin upregulation in mice infected with Pseudomonas aeruginosa. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSear ch=17550583&ordinalpos=10&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel .Pubmed_RVDocSum That's Omega-3, as found in flaxseed oil, for example. and another: Bactericidal activity of different types of honey against clinical and environmental isolates of Pseudomonas aeruginosa. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSear ch=17532737&ordinalpos=11&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel .Pubmed_RVDocSum Personally, I like the taste of honey better than I like Cipro ;-) One question: pseudomonas sounds like another rather ordinary bug that "immunocompetent people" have no problems with. Have you been tested for any sort of immunodeficiency? Incidentally, I saw Ratdog on Friday night. Incredible show :-D Good luck, August. > That's Omega-3, as found in flaxseed oil, for example. Or, better yet, distilled fish oil. > and another: > [quoted text clipped - 8 lines] > "immunocompetent people" have no problems with. Have you been tested > for any sort of immunodeficiency? Pseudomonas is common with steroid use, though. My child had it come up on a throat culture, too, during the years of heavy antibiotics before cure of Lyme disease by an empiric trial of atovaquone/axithromycin combo. Susan > x-no-archive: yes > [quoted text clipped - 20 lines] > > Susan Neil: The paper has not been published yet but I gather from references to it of some work in the Netherlands that the bacteria colonize the adenoids and spread forward from there with each flu/respiratory virus episode in regular immunecompetent patients. The thing about immunecompetent people is that they rarely experience invasive events, the thick pseduomembranes aka biofilm may block the ostemeatal complex and wind up backing up mucus into the frontal and maxilary sinuses, but because you ARE immune competent the goo is not going to drill through into anything important. Unless for some reason that something compromises your immune system. It is only when you become immune compromised for some reason that this disease goes from being life draining to strightup life threatening. So you have an organ transplant or are being treated with steroids for some unrelated malady (like a bumb knee) and wind up with meningitis because the stuff is setting here and your immune response that normally keeps this stuff from drilling to deep has been knocked out, and the ENTs who knew about pseudomembranes and biofilms in the 50s-60s and 70s somewhere in the 80s began to favor idiopathic inflammation over the germ theory. The doc is not there when you can't get to sleep at night because your nose is always shutting down, but people getting worse and dying when they are immune compromised gets their attention, so they concentrate on the immune compromise, not the mat of stuff that had been building up for years that came before. I am also pretty sure that the inflammatory toxins that they produce has a lot to do with blood brain barrier permeability and soluble beta amyloid that these mats make is a major source of high beta amyloid load in the blood stream, both are conditions that are chronicly present in Alzheimer's patients. Who by the way famously loose their sense of smell first. > > x-no-archive: yes > [quoted text clipped - 55 lines] > present in Alzheimer's patients. Who by the way famously loose their > sense of smell first. BTW, Avelox is the new bright and shiny fluoroquinolone, successor to Cipro, http://www.avelox.com/en/patients/bronchitis/role_avelox.html and even they show resistance to zithro in these graphs, it still ramps down the goo so that it can be killed. > > > x-no-archive: yes > [quoted text clipped - 62 lines] > > - Show quoted text - I have tried most of what you all have tried. I've had worsening drainage,congestion, chest and coughing and sleep problems etc. In childhood and adolescence recurring sinus problems were treated with antibiotics and steroid sprays. In middle age the antibiotics had no effect. I have a pool of Pseudo in Max sinus, Cipro didn't clear it. But I have found huge reduction in symptoms from gentle irrigation and daily 250mg Clarithromicin. I also have benefitted from daily biaxin 250 mg after pseudomonas infection. There is a lot of pseudomonas respiratory tract infection in Japan, and they were the first to start to use low dose macrolides. As Elizabeth has said, it doesn't kill the bacteria, just stops it from sticking. It's been a miracle drug for me. Do a pub med search, I used to keep a huge file of abstracts: Judy On Aug 1, 5:43 am, rockets...@talktalk.net wrote: > > > > x-no-archive: yes > [quoted text clipped - 70 lines] > But I have found huge reduction in symptoms from gentle irrigation and > daily 250mg Clarithromicin. >> > x-no-archive: yes >> [quoted text clipped - 61 lines] >and even they show resistance to zithro in these graphs, it still >ramps down the goo so that it can be killed. As I've said before, I'm just glad you're on OUR team ;-) At the risk of sounding like =I'm= becoming a Johnny One-note ... I did another quick bout of digging just to see if my recent "drug of choice," H2O2 had any efficacy with pseudomonas. Short answer: yes, but its presence in/as a biofilm DOES further shield it from H2O2, also. It sounds, to me, as though H2O2 COULD be a useful tool in our battle to kill of viruses, fungi, and bacteria BEFORE they colonize and form biofims ... which really DO sound like the ultimate expression of these bugs. Looking at a paper like this one .... http://www.blackwell-synergy.com/doi/pdf/10.1046/j.1365-2672.1999.00930.x Maybe somebody (Elizabeth??) can weigh in as to whether they agree with my hypothesis, and--if so--at what concentration would the H2O2 likely have to be in order to BE effective? I have a WaterPik with a 600ml reservoir that I fill with - 2tsp sea salt - four drops grapefruit seed extract - 15 drops from a rather large bore (??) 3ml syringe of 35% H2O2 I came to those numbers (for GSE and H2O2) by titrating to stinging. I actually don't know what concentration that achieved, but ... as I said ... for the first time in *years*, my ENT said that my sinuses (with the 'scope) "look like a million bucks." If it were in my lungs, I guess I would use a similar mixture in a bedroom humidifier. Am I conflating correlation with causation, or does anybody think that the science SEEMS to support this notion? TIA, Neil > My sinusitis symptoms have been pretty much the same for quite a while > now. Chronic disease in L maxillary sinus but no acute disease. My lungs [quoted text clipped - 36 lines] > > thanks, AW Thanks for the input everybody. I've paid close attention to everything said. I am immunocompromised but prefer to not list the details here. If interested or you have additional pertinent input feel free to write me privately at waterboredAT gmail.com I see the pulmonologist PA tomorrow morning to discuss taking the Avelox and antibiotic irrigation and make sure she is aware that I had just finished the Cipro when the sputum test was given. I do not want another one week wonder cure then back to the same old same old. I also heard from the nurse of my ID Dr. and I clarified the sequence of events for her. The ID Dr's initial advice was to go ahead and do the Avelox and ask the pulmonologist PA about simultaneous antibiotic irrigation. My appt. with the ID Dr is Aug. 9th. The ID nurse is to call me back today and let me know if the ID Dr has additional input. I have been taking fish oil, flax seed oil and salmon oil daily for numerous years. In the past I have experienced excellent results with macrolide antibiotics on my sinusitis when infection becomes acute. Zithromax taken for 10-20 days has very effective for me on several occaisions. Last Dec. my ENT said I probably should not use Zithromax any more and switched me to Omnicef for acute sinusitis. I'll ask about doing a low dose macrolide when I finish the Avelox to keep the pseudomonas out of my biofilm. I really think I need to do something against the chronic localized infection in my sinuses besides just another oral antibiotic - regardless of whether it is the new wonder antibiotic. Rocketman, the 250mg Clarithromicin you are taking is by mouth? and how long has this been working for you? judy n. How long have you been taking the 250mg Biaxin? Is this a permanent or temporary dosage? Mucomyst is a form of acetylcysteine. I've been taking n-acetyl-cysteine capsules by mouth for years to protect my liver when I take Tylenol. I think it really helps my lungs also but for it to be used for breaking up phlegm I need to take at least a gram 2-3 times daily. N-acetyl-cysteine and guanifenesin was what helped break up all that gunk in my chest. Everyone, thanks again for all the input. It was much appreciated. best, AW Neil, I have some grapeseed extract and if I can gather my courage up I might give irrigating with it a try. Was Kimock playing with Ratdog? > > My sinusitis symptoms have been pretty much the same for quite a while > > now. Chronic disease in L maxillary sinus but no acute disease. My lungs [quoted text clipped - 82 lines] > Neil, I have some grapeseed extract and if I can gather my courage up I > might give irrigating with it a try. Was Kimock playing with Ratdog? Augest. If there is a a class of antibiotics that I would think twice about using, it is the floroquinolones, the Leviquin, Avelox, and Cipro. I run. When I was put on Leviquin the sides of my heels started to hurt. When I was being actively treated with quinolones and Serrapeptase, one or the other or both, I would wake up with my feet hurting. About a year after my last use of any of these drugs my feet stopped hurting. They are fine now. These drugs also have other side effects but I think the most important thing is that they are otto toxic sp? anyway I think that they need to ' be used simultanously and in combination with a macrolide because I think because they are otto toxic, they may damage cilia as well as killing the bacteria, So once they are discontinued, is a race to see who recovers first and your big eucaryote cells devide a lot slower when than the little buggy ones when they want to get busy. So you I think you need the macrolide to keep them in check while you recover from the floroquinolone. Clarithromicin, aka Biaxin has never given me this kind of problem. > If there is a a class of antibiotics that I would think twice about > using, it is the floroquinolones, the Leviquin, Avelox, and Cipro. [quoted text clipped - 18 lines] > > Clarithromicin, aka Biaxin has never given me this kind of problem. Elizabeth, I know many tinnitus sufferers whose T started with the use of macrolides, Biaxin in particular. It's true that the quinolones can also be ototoxic. Additionally, they're notorious for causing tendon damage, and that's very likely what you experienced. In some cases, they're known to induce psychosis or other psychiatric disturbance. Susan > Augest. > [quoted text clipped - 20 lines] > > Clarithromicin, aka Biaxin has never given me this kind of problem. Thanks very much for the quick answer although frankly the idea of ototoxicity scares the hell out of me. I already have significant upper range hearing loss and tinnitus. I'll make sure and address this issue very carefully. I may just wait until I see my ID Dr although she tends to be rather fatalistic about drug side effects IMO. I do not think I would make a good deaf person. I did note that there were trials to see if n-acteyl-cysteine might reduce drug induced ototoxicity. I was aware of the tendon issue and I usually take it easy while on antibiotics because drugs like Cipro make me photosensitive. thanks again, AW >Neil, I have some grapeseed extract and if I can gather my courage up I >might give irrigating with it a try. Was Kimock playing with Ratdog? All the best of luck to you on this, August. I feel for you. I'm sure we all do. ==== Quick OT setlist ... just for August: I: Jam > Tomorrow Never Knows > Playin in the Band > Jus' Like Mama Said > Dark Star > Book of Rules > Odessa > Dark Star Jam > Deal II: El Paso, Mexicali Blues, West L.A. Fadeaway* > Ashes and Glass* > Stuff* > Black Peter+ > Touch of Grey E: Johnny B. Goode* Show with Steve Kimock (Guitar); *-with Bobby Cochran (Guitar); +-with Keller Williams (Guitar/Vocals); Mark was absent; Stuff - Kenny/Jay/Robin/Steve/Cochran; Bobby sat in with Keller on "Jack-A-Roe" and "Wake Up Little Suzie" (Keller Williams opened) > On Wed, 1 Aug 2007 14:58:54 -0700, "august" > [quoted text clipped - 21 lines] > Bobby sat in with Keller on "Jack-A-Roe" and "Wake Up Little Suzie" > (Keller Williams opened) To August I take one 250mg Clarithromicin with breakfast daily. I am told however that it may be poss to reduce it to one tablet every other day. This may be because they say Macrolides have a long half life in the body. August: I also take one biaxin 250mg/day with dinner. The drug and dose were based on the work by Anders Cervin, who studied patients who had failed several sinus surgeries: he used either 250 mg of erythromycin twice a day, biaxin 250 mg daily or roxithryomycin (not available in the US.) Studies in Japan used erythromycin as either 200mg or 400 mg EES daily, and showed less pseudomonas and far less respiratory infections due to the macrolide preventing adherence in the nose. My ENT has empirically decided to use azithromycin as 250mg either once or twice a week with suitable patients, and follows them closely and has gotten excellent results. He decides if they need the second dose based on symptoms. I've been on the biaxin for 5 years, and never intend to stop it. Ironically, I had a patient on long term erythromycin due to an infected pacemaker wire that couldn't be removed, and I thought of him when I started. He was on it for decades. For cystic fibrosis patients the protocol is different, they use bursts of higher dose azithromycin to prevent colonization with the pseudomonas. For years we treated patients with acne and roseacea with long term low dose macrolides and/or tetracylines, and no one raised a fuss about resistance. Now they've developed a low dose doxycylcine for roseacea that has no antimicrobial effect. Good luck. My mother is chronically immunosuppressed due to a liver transplant, and she has (knock on wood) enjoyed excellent health. I hope you feel better soon. Realize we all mean well, but will be giving conflicting advice. I hope it's not confusing. Judy On Aug 2, 4:19 am, rockets...@talktalk.net wrote: > > On Wed, 1 Aug 2007 14:58:54 -0700, "august" > [quoted text clipped - 27 lines] > day. This may be because they say Macrolides have a long half life in > the body. > My sinusitis symptoms have been pretty much the same for quite a while > now. Chronic disease in L maxillary sinus but no acute disease. My lungs [quoted text clipped - 36 lines] > > thanks, AW I went thursday to the pulmonologist PA who also administered a spirometry test. My lungs checked out much better now (after being on Spiriva and Flovent inhaler) but of course my sinuses still show chronic infection and produce yellow phlegm. The pulmonology PA said to still take the Avelox which would knock back the pseudomonas infection but not cure the colonization. I held off on starting the Avelox because I felt better, was not running a fever, and because I had my 3 month ck-up with my hemetologist on friday. He said that unless I did multi drug IV antibiotics that I had no chance of actually curing the pseudomonas and that if I tried that treatment and failed it could be harmful to me. If the IV therapy failed I would certainly become antibiotic resistant and then if I ever came down with pneumonia or other new pseudomonas infection then I would have no effective treatment available to me. I want to keep all the arrows in my effective treatment quiver that I can - so until I get worse the Avelox is on hold. I now plan on talking to my ENT about the low dose macrolide option and also plan on trying some different irrigation formulas. Thanks to everyone for their input. I am curious about whether the people who have tried long term low dose macrolide therapy have had their chronic sinusitis improve symptomatically and can breathe better or just have fewer acute infections? Any drawbacks or side effects that you have noticed? If you need antibiotic therapy for a different health issue do you stop the macrolide therapy for the time being? sorry if this posting formats poorly. I cut and pasted some of it from a private email. thanks again for everyone's input, AW On low dose biaxin, I've noticed less sinusitis episodes: dramatically--from 5-6 year to none for the last couple of years. I get mildly ill with URI's but it doesn't turn nasty like it used to. I actually emailed Anders Cervin in Sweden when I did have a flare early on: he told me that his protocol was to treat with Augmentin and continue the macrolide. If, however, you need a quninolone, you have to stop the macrolide, as both cause QT prolongtion, and can cause heart arrhytmias. Personally, I haven't had any significant side effects. I did start on erythromycin twice a day, and I was getting nausea, and switched to the once a day biaxin, which I take with dinner--my largest meal. It was a gradual progression from frequent sinusitis, to less freqeunt episodes, to a sort of remission. That's my personal experience. Good luck. Judy > > My sinusitis symptoms have been pretty much the same for quite a while > > now. Chronic disease in L maxillary sinus but no acute disease. My lungs [quoted text clipped - 71 lines] > > thanks again for everyone's input, AW > On low dose biaxin, I've noticed less sinusitis episodes: > dramatically--from 5-6 year to none for the last couple of years. I [quoted text clipped - 12 lines] > Good luck. > Judy Thanks very much Judy. I see my ID Dr tomorrow. I googled Anders Cervin and got numerous interesting reads. I'll ask about doing the low dose macrolide therapy and get her thoughts and hopefully a treatment plan. I was also amazed at how many commercial web sites copy entire sections of postings from alt.support.sinusitis and then include the messages on their web pages. AW > > On low dose biaxin, I've noticed less sinusitis episodes: > > dramatically--from 5-6 year to none for the last couple of years. I [quoted text clipped - 24 lines] > > - Show quoted text - I have little side effects from Clarithromicin, occasional spots on face, and I take a probiotic daily (Acidophilus). The way I treat infection is by Gentamicin, 1 x 2ml vial in 1 litre normal saline solution and irrigate with it for about a week. I have very few infection episodes but do still have PND, sometimes thats a real pain my mother has chronic sinusitis problem, she has been on many alopathic medication, but there was no improvement. it continued for almost 18 years. then somebody suggested some ayuverdic treatment. she was really showing some improvements. but finally she got to know of yoga treatments available for it. and believe me she is 90% fit /relieved now. i had read somewhere thgat there is no treatment for sinusitis in modern medical technology, but i have seen improvement myself vikram -------------------- get more info from Universal Technical Institute on programs of your choice http://snipurl.com/-uti |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.