Persistent maxillary sinusitis and bronchitis for 38 days despite Levaquin&Augmenti

[FearlessYeti]

Forgive me for reposting this, but I noticed that there were very few views of most threads on the Cold and Flu board where I posted it originally. I guess allergies have more to do with immunology anyway, so it might fit better in this forum.

Sex: Male
Age: 23 (24 in Dec.)

Hi
I've always had strange immunological issues which are pretty ambiguous and haven't been pinned down yet, including symptoms mirroring wegener's, CF, SLE, sarcoidosis, etc. and my labs have always shown significantly increased histamine and eosinophil levels. (However I always test negative for ANAs, RF, sweat test, etc. - I still need my ACE checked but they are stubborn about that; seeing immunology on Nov. 9th to try and make some headway). Chest X-rays and sinus CT are always normal (beyond normal; the picture of health, apart from some pronounced broadening of my lung space)

Anyway, this has always been passed off as "allergies" and "asthma," and tends to result in unusually severe upper respiratory infections at least once or twice a year. (Usually more). They also coincide with unusual tertiary symptoms including those of the above mentioned syndromes which, presumably, I don't have. I also experience muscle weakness, occasionally to the point of not being able to walk without a cane. Typically I'm treated with Augmentin and/or Erythromycin for 21 days, and it resolves.

For some reason, this year has been particularly miserable. I've had five of these episodes beginning in January, and with the exception of this current one, they have occured precisely two months apart to the day. Sputum specimens and throat cultures don't show any bacteria resistance to beta lactam antibiotics, and no anaerobes.

This last one however has persisted despite our best efforts. Today is day thirty eight of it, despite 28 days of Levofloxacin (this was an attempt to use the greater penetration and lack of cross resistance between beta lactams and fluoroquinolones to stop it from coming back, just in case the lab missed something resistant), which was ruled a clinical failure, and (so far) 11 days of Augmentin (which they put me back on despite concerns of beta lactam antibiotic resistance ...) At the end of 14 days, they will reassess and decide whether to give me seven to ten more days. At the moment, I actually feel worse, rather than better.

In the past, concurrent Augmentin and Erythromycin did the trick in this kind of situation, but my doctor is reluctant to give me another antibiotic, opting to see whether this is all just an immunological "episode" that will pass on it's own. That may well be the underlying cause, and I'm well aware of the concern about resistance being bred, but I also know what sinusitis smells and tastes (literally - sorry to be gross) like and that by not taking the gloves off we are making it stronger. This is a bacterial infection, and needs to be more effectively (and in my opinion, more agressively) treated. If I had my way I'd be on Moxifloxacin or Clarythromycin and along with more Augmentin. But I'm just the patient, so what do I know?

I can't afford to see anyone else, as I have only city provided health coverage and very little money. Can immunologists prescribe?

Suggestions?

[Titchou]

Certainly immunologists can prescribe....they are physicians. I go to one for my allergies and asthma. Have you tried any sinus irrigation to flush out the mucous?

[FearlessYeti]

Yeah, I do it all. Irrigation, humidity, dehumidity, saline spray, more fluids than any person should be able to consume... lol.

I'm on singulair, zyrtec, nasocort, albuterol, pulmicort, ibuprofen, sudafed, guaifenesin, and they even prescribed famotadine (pepcid) since it blocks a receptor responsible for histamine production in addition to its antacid effects. Basically everything short of prednisone, which has worked to great effect in the past.

Oh, see, an otolaryngologist once told me they couldn't prescribe antibiotics because they "weren't my doctor." I guess what he meant was "wouldn't," not "couldn't." lol

So provided I can hold out until the 9th (I'll run out of these on the 3rd if they give me one more week) maybe the immunologist will listen to me and prescribe something a little less first or second line-ish.

Interesting side note: macrolides like erythromycin and clarithromycin tend to work better on me. So I did some research, and even though they aren't as effective as other things a doctor would tend to prescribe instead of those (at least in the case of sinusitis), there is a mucoregulatory effect that they are only now beginning to document in any sort of comprehensive way, brought about by macrolide treatment. Apparently it impacts ciliary function, and reduces the density of secretions, completely independent from it's antibiotic effects (i.e. the latter doesn't cause thr former - they aren't sure what does, yet).

[Titchou]

Wish you hadn't told me that about mycins....had taken them for years will no ill effects until a sinus infection last year....cleared it up but I spiked a fever and my lips blistered...so now we add those to the growing list of antibiotics I can't take....which is most of the ones you've taken! Hope I don't get another snus infection...

[sneezydiva]

Wow! You are really suffering! I take zyrtec, flonase, singulair, sudaphed/guaifenesin and patanol eyedrops. I was like you with recurrent sinus infections and bronchitits. My sinus CT's also didn't look "too bad" but I hate to say it, but I never got complete relief until after I had sinus surgery.

One thing you should ask about is getting some prednisone. My allergist would prescribe a short taper with the Leviquin or Augmentin and it helped clear the infection much faster than the antibiotic alone. You'll get horrible PND for a while, but that means the sinus tissues are less swollen and stuff is finally able to drain.

You also sound like a candidate for allergy shots, if you can get them.