Antibiotics

Q. Does Azithromycin make existing tinnitus worse?

A. It can in some but not all patients. If it does then things usually return to how they were before when the azithromycin is stopped. It is very unlikely to cause tinnitus if you do not have it already. It is a good prophylactic antibiotic so it is worth trying if you are having lots of symptoms.  As always discuss with your immunology team.

Q. What is the current progress with the recent antibiotic scare?  Will PID patients become resistant and what are the plans for this?

A. There has been a lot in press on super bugs and the fact that we will not be able to treat any infections soon. This is a concern in some situations but not all. For patients with antibody deficiencies such as CVID the majority of the infections are in the respiratory tract, nose, throat or chest. The antibiotics we commonly use such as penicillin, azithromycin, doxycycline and ciprofloxacin are still effective in killing the bugs that cause these infections.

It is essential that before any antibiotics are started that we get a sputum sample which is sent for culture so we can see if routine treatments will work. If you have previously had resistant bugs then this will alter what we give you with a new infection. If your symptoms do not improve with antibiotics either you do not have a bacterial infection (perhaps it’s a viral infection or asthma) or the bug we are treating is possibly resistant. Please discuss with your immunology team.

Q. I started infusions about 6 months ago and have had my first infection over the weekend. Should I take the emergency antibiotics I have at home and then ring my immunology centre on Monday, or wait until Monday and get a doctors appointment?

A. Your clinic should give you advice about how to manage intercurrent infection.  If you are not sure that you are unwell enough to need to take antibiotics, they may not be needed and you could wait until Monday.  If it is a definite bacterial infection, then you should start antibiotics, following the guidance given to you by the prescriber and then let the clinic know as soon as you can (e.g. after the weekend).  Lots of clinics would like you to provide a sputum sample for analysis just before you start antibiotics if possible and may have provided you with sputum pots for that purpose.

Q. My daughter has been on antibiotics for the last year but is still having recurrent infections. Her Paediatrician is referring her to an Immunologist and has suggested either different antibiotics or immunoglobulin infusions. Which treatment course would be best for her?

A. Your daughter’s Paediatrician is right to refer her to an Immunologist. They will conduct more tests and look at her levels, they will then decide which treatment option is best.

Q. What are the pros and cons of taking prophylactic antibiotics versus taking ad hoc antibiotics i.e. when they are needed?

A. Your doctor will decide what is most appropriate on the medical history and frequency of infections. Treating each infection as they come, if they are frequent, by antibiotics allows inflammation in the tissues and may cause damage e.g. bronchiectasis or chronic sinus disease.  A few infections will always occur, but if this is less than 3-4 times per year, long term health complications are unlikely.  Preventative antibiotics will help break the cycle of recurrent infection and tissue damage.  In some people they will also slow down the rate of invasive infection, the function your immune system normally undertakes.  That gives time to get to a doctor or hospital for serious infection and then receive the appropriate treatment, without a more serious e.g. sepsis occurring. Take a look at our antibiotic information here.

Q. Is it helpful to take probiotics when you are taking antibiotics?

A. People who are on antibiotics may benefit from taking probiotics at the same time, a review of evidence has shown. Read more at http://www.bbc.com/future/story/20190124-is-it-worth-taking-probiotics-after-antibiotics This may help people with primary antibody deficiency but make sure your probiotic products are from a reputable company with quality assurance as to the strains contained within them.

Q. I have a PID and I take antibiotics on a regular basis and I'm worried about developing antibiotic resistance.  What advice can you give?

A. Individuals colonized with or exposed to certain bacteria may develop antimicrobial resistance. This will  require a change in therapy so that the particular bacteria is eradicated. Where eradication is not possible, there may still be better suppression with an alternative agent and the resistant strain may die out allowing the original agent to be effective again. Antibiotic prophylaxis is only advocated when all the benefits outweigh all the risks and resistance is one of those.

These FAQs were reviewed by Dr Matthew Buckland, Chairman of our Medical Advisory Panel, March 2018.