Medical Forum / Diseases and Disorders / Sinusitis / April 2008
Chronic Sinus infection
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MR - 20 Apr 2008 20:37 GMT Hi all,
I've been dealing with a chronic sinus infection for about 6 months now. I've been on all sorts of antibiotics including Augmentin, Amoxicillin, Cipro, Levoquin, Tetracycline and nothing is getting rid of it!
I've even tried a Neti pot, but it really irritated my sinuses after using it and made my nasal passages bloody and raw. I really don't want to get surgery, but I'm running out of options. There isn't any foul colored discharge or anything, only clogged nasal passages, dry cough in the mornings, and sinus pain with the occasional headache.
I regularly use Afrin nasal spray and a steamer to keep my nasal passages moist, but I don't use it everyday. What can I do to get rid of this sinus infection??
Thanks,
Michelle
Steven L. - 20 Apr 2008 22:26 GMT > Hi all, > [quoted text clipped - 11 lines] > moist, but I don't use it everyday. What can I do to get rid of this sinus > infection?? See an ENT and get a CT scan of your sinuses. It's past time to see what's going on inside there.
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MR - 20 Apr 2008 22:52 GMT "Steven L." <sdlitvin@earthlink.net> wrote in message
> See an ENT and get a CT scan of your sinuses. It's past time to see > what's going on inside there. I had a CT scan done back in February, they told me that I had a sinus infection and put me on Augmentin. I'm going back to see an ENT though.
truehawk - 21 Apr 2008 01:24 GMT > "Steven L." <sdlit...@earthlink.net> wrote in message > [quoted text clipped - 3 lines] > I had a CT scan done back in February, they told me that I had a sinus > infection and put me on Augmentin. I'm going back to see an ENT though. Time to try clarithromycin , AKA (biaxin), and intraconazole (sporanox), prilosec and peptobismol tablets.
Go to pubmed.gov and type in "biofilm sinusitis" and read what comes up. Do some further research on biofilms because you are not dealing with one type of microbe, you are dealing with a microbial community. You get chronic sinusitis by after having the flu, when cilia and goblet cells are killed by the virus. Bacteria move into the damaged area while you defenses are down. Who moves in is whoever happens to be on your tonsils and adenoid area, plus whatever bacteria happen to be riding on the dust you breath in. Bacteria cling to surfaces, they cling to dust. On the average air contains about 2000 bacteria per cubic centimeter. In dusty conditions that can go up to a 1,000,000. The medical community has characterized 640 or so human pathogens but there are billions of types of bacteria, most of which will not grow in the type of monocultures used for bacterial characterization in the last century. Bacteria have a single cell wall and carry their DNA in rings called plasmids throughout their cytoplasm. Bacteria generate little prickles called sexual pilia and swap plasmids whenever they are under stress in a process called bacterial conjugation, so the bacteria that you have can be somewhat different from the similar looking bacteria from the next town over. Usually bacteria are classified into species by their shape, their gram stain (gram positive or negative), which nutrients they metabolize, and the toxins that they carry. Bacteria of the Drugs may be standard, but the bacteria are not. http://en.wikipedia.org/wiki/Bacterial_conjugation One can find Staph, fungi, e-coli, actinomycetes and many others living together in the biofilm and each one is resistant to the antibiotics that inhibits or kills the other. Search on "Calgary Biofilm Device" to get some idea.
Bacteria that can be easily killed by amoxicillian in the free floating state become effectively immune when growing in a biofilm. I a biofilm about 15% of the microbiotia, including fungi are dormant. They do not grow and they do not die in the presence of the antibiotic or antifungal. Only a few antibiotics are effective once they have formed Voltron. http://www.ncbi.nlm.nih.gov/pubmed/14734160
Despite their wild variability, most of the bugs that bother us live in biofilms and share an attachment strategy. They make beta amyloid to hold themselves together and to the host cell surfaces. Staph uses the fribronectin protein in plasma from wounds that it creates to produce a clear springy insoluible mucus that serves the same purpose. Macrolide antibiotics, such as Biaxin, not only inhibit the reproduction of the bacteria, they interfere with the production of the extracellular goo that they produce to call home. It not only takes just the right combination of antibiotics to kill a bacterial biofilm, because of the presistor cells, the length of the course of antibiotics that is necessary to get rid of the infection is usually greater than the length of the course of antibiotics that the doctor is willing to prescribe. There are however some agents that can be used to help to peal the film off a bit. Look at the older post on the board and you will find reference to Michaels tea wash, pecan tannins, splenda, and the use of Canada balsam hair conditioner (which is gentle to the nose but contains steryl alcohol, steralkonium cloride, glycerin, balsam canada, EDTA and citric acid, all things which help depolymerize the god-awful goo). At this point you are in for some pain whenever you wash your nose out, so take some Advil in advance, unless you are allergic to asprin, because the inside of your nose is going to be raw under the blanket of bugs that are chowing down on it. When they come off the area will probably bleed a bit. Also the toxins in the post nasal drip can give you severe heartburn, which will temporarily be much worse when you try to get rid of them.
By the way. The bugs have their enemies too. Lysic phages. http://www.phagetherapycenter.com/pii/PatientServlet?command=static_home
truehawk - 21 Apr 2008 04:39 GMT > > "Steven L." <sdlit...@earthlink.net> wrote in message > [quoted text clipped - 74 lines] > > By the way. The bugs have their enemies too. Lysic phages.http://www.phagetherapycenter.com/pii/PatientServlet?command=static_home Also according to http://www.ncbi.nlm.nih.gov/pubmed/15980094?ordinalpos=1&itool=EntrezSystem2.PEn trez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpo s=4
"While the biofilm phenotype is highly resistant to antibiotics that target cell wall synthesis, it is fairly susceptible to antibiotics that target RNA and protein synthesis."
From the MIT open course work on toxins and antibiotics that inhibit protein synthesis http://ocw.mit.edu/OcwWeb/Biology/7-344Spring-2007/Readings/index.htm It looks like the some of the aminoglycoside antibiotics which include amikacin, gentamicin, kanamycin, neomycin, netilmicin, paromomycin, rhodostreptomycin[2], streptomycin, tobramycin, and apramycin might also be of use.
Johnny1000@webtv.net - 21 Apr 2008 23:45 GMT >Time to try clarithromycin , AKA (biaxin) It sure worked wonders for me. ..Although, I did develop an odd skin rash while I was on it. ...Jon
Steven L. - 22 Apr 2008 00:44 GMT >> Time to try clarithromycin , AKA (biaxin) I don't agree.
After multiple courses of antibiotics have failed, the right thing to do is find out what's happening inside your sinuses, *NOT* to keep throwing more and different antibiotics at the problem. I'm a fan of "three strikes and you're out"--after 3 different types of antibiotics have failed, give up and see an ENT for other treatment.
> It sure worked wonders for me. ..Although, I did develop an odd skin > rash while I was on it. ...Jon It used to work for me years ago. But then it stopped working on my sinus infections. I can still use it for other types of infections though.
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truehawk - 22 Apr 2008 01:39 GMT > Johnny1...@webtv.net wrote: > >> Time to try clarithromycin , AKA (biaxin) [quoted text clipped - 17 lines] > Email: sdlit...@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. And Steven: By all means do what you feel is right for you. How is your approach working for you? How is it working out for you? You have had how many surgeries? Taken your sinuses for that tropical vacation and still got it? A biofilm sinus infection can not be erradicated by giving multiple courses of the wrong antibiotics (those that interfere with cell wall synthesis like the "cillians which work okay for rapidly dividing planktonic bacteria but are totally ineffective for a biofilm) for a time period that is too brief (it takes a minimum of 3 weeks and longer for presistor cells to wake up and ingest the antibiotic) . Using the best doseing schedule it is very difficult to eradicate at all, using the bone head one that most ENTs and GPs suscribe to it is impossible. But it can be cured with phages and ince most of the human pathogens use one attachment strategy, ie making soluble beta amyloid, and precipitating curli out of solution to bungee themselves in place, there is a good chance that an anti-amyloid vaccine would cure not only sinusitis, but a lot of other amyloid diseases.
Johnny1000@webtv.net - 22 Apr 2008 02:52 GMT sdlitvin@earthlink.net (Steven L.) wrote:
>I don't agree. > [quoted text clipped - 3 lines] > keep throwing more and different antibiotics > at the problem. Well everyone is different. Some people tend to suffer more than others.
During my last flair-up, levaquin did nothing. ...And I have to say that had I tried amoxil, or some other common brand, I'm sure they wouldn't have helped either. However, when I do get an antibiotic that works, like Biaxin did this last time, it seems it will allow me to plod along for another 3 or 4 years without any major flair-ups. Of course I realize I've still got the underlying sinus condition, but for me, I can justify a 2 or 3 week stretch of antibiotics every few years, as opposed to undergoing some major nasal altering operation, that may or may not work, and could possibly, make things worse. ...Jon
truehawk - 22 Apr 2008 01:22 GMT On Apr 21, 6:45 pm, Johnny1...@webtv.net wrote:
> >Time to try clarithromycin , AKA (biaxin) > > It sure worked wonders for me. ..Although, I did develop an odd skin > rash while I was on it. ...Jon Endotoxin. Some of the bugs release superantigens when their cell membranes are ruptured.
Susan - 22 Apr 2008 01:59 GMT > Endotoxin. Some of the bugs release superantigens when their cell > membranes are ruptured. That's very possible, though the most typical reaction in that case is hives.
It could also be a reaction to the reduced corticosteroid clearance inducing a rash, too.
Or some other reaction.
Susan
judy.n - 22 Apr 2008 23:21 GMT > On Apr 21, 6:45 pm, Johnny1...@webtv.net wrote: > [quoted text clipped - 5 lines] > Endotoxin. Some of the bugs release superantigens when their cell > membranes are ruptured. The initial post mentioned frequent use of afrin--that's a problem--it causes toxicity if used for more than 3 days and it contains a harmful preservative. No wonder your tissues are raw. Steam is fine, afrin is not. Getting off the afrin may require a course of oral prednisone--you need to let your ENT know that you are over-using nasal decongestants. And, listen to Elizabeth---her knowledge is amazing. Judy
Susan - 23 Apr 2008 00:26 GMT > Getting off the afrin may require a course of oral prednisone--you > need to let your ENT know that you are over-using nasal decongestants. > And, listen to Elizabeth---her knowledge is amazing. > Judy Oy, Judy, Prednisone is trading one danger for another, worse one.
Susan
Terry Raymond - 23 Apr 2008 00:37 GMT "judy.n" <judy.nudelman@gmail.com> wrote in news:d4fcaf13-8f48-43b7-bc5e- ecdff85322ee@m36g2000hse.googlegroups.com:
> The initial post mentioned frequent use of afrin--that's a problem--it > causes toxicity if used for more than 3 days and it contains a harmful [quoted text clipped - 4 lines] > And, listen to Elizabeth---her knowledge is amazing. > Judy I like to alternate one day using afrin and the next day using pseudphredrine.
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Steven L. - 21 Apr 2008 02:56 GMT > "Steven L." <sdlitvin@earthlink.net> wrote in message >> See an ENT and get a CT scan of your sinuses. It's past time to see >> what's going on inside there. > > I had a CT scan done back in February, they told me that I had a sinus > infection and put me on Augmentin. I'm going back to see an ENT though. That's all they said??? Didn't the radiologist at least report on the condition of your sinuses, whether the linings are swollen, the status of your septum, etc.?
Get a copy of the radiologist's report and post it here. Maybe we can suggest some more things.
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MR - 23 Apr 2008 17:24 GMT > > "Steven L." <sdlitvin@earthlink.net> wrote in message > >> See an ENT and get a CT scan of your sinuses. It's past time to see [quoted text clipped - 9 lines] > Get a copy of the radiologist's report and post it here. Maybe we can > suggest some more things. Hi Steve,
Yes, that's all he said, but then again this was in the emergency room. I had gone there for dizziness and fatigue. I'm going to get a copy of my radiologist's report and post it. I have an appointment with the ENT, but it's not until next month.
Thanks to everyone else for all of the advice.
Michelle
dolysods@yahoo.com - 21 Apr 2008 17:32 GMT > Hi all, > [quoted text clipped - 15 lines] > > Michelle How much salt are you using in the neti? is it the salt that came with it? I love the sinucleanse packets that i get from CVS. They have some baking soda in them. It says to use 1-2 packets but i can only use 1/2 per side. I hate it when i don't have enough time to irrigate.
MR - 23 Apr 2008 17:26 GMT <dolysods@yahoo.com> wrote in message:
> How much salt are you using in the neti? is it the salt that came with > it? I love the sinucleanse packets that i get from CVS. They have > some baking soda in them. It says to use 1-2 packets but i can only > use 1/2 per side. I hate it when i don't have enough time to > irrigate. I use sinucleanse too. 1/2 a package each nostril. I was using 1 package per nostril but it was too irritating.
Michelle
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