Ever Discouraged Not To Take Antibiotics?

Posted by Beth Kiefer @mrf5629, Sep 22 12:38pm

I’m confused by my pulmonologist’s discouraging me from taking antibiotics for exacerbation because “based on the CT scan my Bronchiectasis is mild and there appears to be no infection. Even though I religious follow my airway clearance and nebulizer protocols, my sputum had turned from my usual clear raw egg whites consistency to thick, dark colored and very difficult to cough up, and my O2 sats had dropped to 90, so I was asking if I could start an antibiotic. This confuses me because doing a ZPak is the only thing that helps break it up when an infection is starting. Has anybody else received similar advice? It seems so counterproductive to allow the mucus to get thick and damage my lungs further rather than to treat exacerbation early. Most of what I’ve read indicates patients need to get rid of that stuff to minimize the damage.

@mrf5629…When the doctor chooses not to prescribe an anti-biotic, it is hard to understand why. Zpak works for me as well. You may want to request that your sputum sample be sent for evaluation to prove an infection. You could also increase water intake and take Mucinex to thin your mucus while waiting.
Since Bronchiectasis is a chronic disease, your doctor may want to keep anti-biotics for severe infections. He expects you to live a long time and need them in the future. keep up the nebulizer and airway clearance.

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Hi Beth, I know it seems counterintuitive to NOT treat what seems to be an infection, but here's the logic behind it.

First keep in mind that many causes of discolored mucus can be viral in nature, and do not respond to antibiotics. They simply "run their course " while you are taking the ZPak and things coincidentally return to normal.

People with bronchiectasis and COPD are vulnerable to several slow growing and difficult infectious organisms including various Mycobacteria and Pseudomonas. Neither of these infections can be "knocked out" with a short course of a single antibiotic. In fact, repeated short doses can build resistant organisms in your lungs and elsewhere in your body.

The usual course of treatment for infection is to do a sputum culture to determine the exact infectious organism, followed by sensitivity testing to determine which antibiotics are needed to treat it.

Pseudomonas may respond to one or two courses of a .Chlorquinolone like Levaquin, or may require a course of inhaled (nebulized) antibiotic like Tobramycin.

MAC often requires 18 months or longer of a 3-4 antibiotic regimen, either 3 times weekly or daily. It is very hard on the body, and may not eradicate the infection.

Because of the difficulty of treatment, many pulmonologists discourage early antibiotic use absent clear evidence of infectious pockets.

My MAC was treated for 18 months and didn't go away (it did get better) but my body could no longer tolerate the side effects. We stopped antibiotics, but I continue airway clearance with 7% saline solution and an Aerobika to bring up mucus. During an exacerbation I add a neb of Levalbuterol. I also get exercise daily through fast walking or vigorous play with my grands, for whom I provide daycare. This has kept me healthy for 9 months now.

Has your doc done or suggested a sputum culture? I'll check back later to see if you have any questions.
Sue

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So this isn’t as unusual as I thought. I’m just so scared of it progressing and in my mind I see that stuff attacking my lungs like an army. Thanks Sue.

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@egayle187

@mrf5629…When the doctor chooses not to prescribe an anti-biotic, it is hard to understand why. Zpak works for me as well. You may want to request that your sputum sample be sent for evaluation to prove an infection. You could also increase water intake and take Mucinex to thin your mucus while waiting.
Since Bronchiectasis is a chronic disease, your doctor may want to keep anti-biotics for severe infections. He expects you to live a long time and need them in the future. keep up the nebulizer and airway clearance.

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Thank you egayle.

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@mrf5629

Thank you egayle.

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Do you do any airway clearance to keep from mucus building up in your lungs? Like an Acapela or Aerobika device after the neb?

And have they checked your sputum to see exactly what is infecting you?

Overuse of antibiotics, especially the seemingly innocuous ZPak, is causing more antibiotic resistant organisms. This is why docs are becoming more reluctant to prescribing them without knowing exactly what is going on in your body.

Both of my daughters, my sister, several friends and nieces are nurses, so this has been a frequent topic of conversation in our house for many years.

Recently my grandson had positive strep, but the pediatrician only gave him one high dose penicillin shot and no oral antibiotics, and he recovered fine.

Sue

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@sueinmn

Do you do any airway clearance to keep from mucus building up in your lungs? Like an Acapela or Aerobika device after the neb?

And have they checked your sputum to see exactly what is infecting you?

Overuse of antibiotics, especially the seemingly innocuous ZPak, is causing more antibiotic resistant organisms. This is why docs are becoming more reluctant to prescribing them without knowing exactly what is going on in your body.

Both of my daughters, my sister, several friends and nieces are nurses, so this has been a frequent topic of conversation in our house for many years.

Recently my grandson had positive strep, but the pediatrician only gave him one high dose penicillin shot and no oral antibiotics, and he recovered fine.

Sue

Jump to this post

Sue and Beth, my dr at Mayo said to stay away from zpaks, he retired, and the dr that replaced him said the same thing. There are other effective broad spectrum antibiotics that will work instead. Their reasoning being, like you said Sue, is they don't want you to become resistant to the zpa, (Azithromycin). It is considered a 'Big Gun' in the antibiotic field, and the Mayo docs believe it should be used as a last resort treatment up the road should you become resistant to all other antibiotics.

REPLY
@sueinmn

Hi Beth, I know it seems counterintuitive to NOT treat what seems to be an infection, but here's the logic behind it.

First keep in mind that many causes of discolored mucus can be viral in nature, and do not respond to antibiotics. They simply "run their course " while you are taking the ZPak and things coincidentally return to normal.

People with bronchiectasis and COPD are vulnerable to several slow growing and difficult infectious organisms including various Mycobacteria and Pseudomonas. Neither of these infections can be "knocked out" with a short course of a single antibiotic. In fact, repeated short doses can build resistant organisms in your lungs and elsewhere in your body.

The usual course of treatment for infection is to do a sputum culture to determine the exact infectious organism, followed by sensitivity testing to determine which antibiotics are needed to treat it.

Pseudomonas may respond to one or two courses of a .Chlorquinolone like Levaquin, or may require a course of inhaled (nebulized) antibiotic like Tobramycin.

MAC often requires 18 months or longer of a 3-4 antibiotic regimen, either 3 times weekly or daily. It is very hard on the body, and may not eradicate the infection.

Because of the difficulty of treatment, many pulmonologists discourage early antibiotic use absent clear evidence of infectious pockets.

My MAC was treated for 18 months and didn't go away (it did get better) but my body could no longer tolerate the side effects. We stopped antibiotics, but I continue airway clearance with 7% saline solution and an Aerobika to bring up mucus. During an exacerbation I add a neb of Levalbuterol. I also get exercise daily through fast walking or vigorous play with my grands, for whom I provide daycare. This has kept me healthy for 9 months now.

Has your doc done or suggested a sputum culture? I'll check back later to see if you have any questions.
Sue

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Sue, great response post!

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@windwalker

Sue and Beth, my dr at Mayo said to stay away from zpaks, he retired, and the dr that replaced him said the same thing. There are other effective broad spectrum antibiotics that will work instead. Their reasoning being, like you said Sue, is they don't want you to become resistant to the zpa, (Azithromycin). It is considered a 'Big Gun' in the antibiotic field, and the Mayo docs believe it should be used as a last resort treatment up the road should you become resistant to all other antibiotics.

Jump to this post

Thank you Terri. So am I understanding correctly that your doctor does prescribe an antibiotic when you have an infection, just not ZPak? My physician is at Mayo also. The first one I saw had me use ZPak but the one I gave now, who is not a physician on staff, doesn’t want me to use it and has prescribed nothing else.

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@mrf5629

Thank you Terri. So am I understanding correctly that your doctor does prescribe an antibiotic when you have an infection, just not ZPak? My physician is at Mayo also. The first one I saw had me use ZPak but the one I gave now, who is not a physician on staff, doesn’t want me to use it and has prescribed nothing else.

Jump to this post

Hi Beth. Have you asked your dr why they do not want to treat it at all?

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