Too many antibiotics - almost unheard of immune response, should I complain?

GlasweJen

I've had a sinus infection since the end of 2009 and my doctor has referred me to ENT to try get it sorted. When it got really bad he gave me amoxicillin 500mg, three weeks later it was still there and causing old brown blood to flow out my nose so he gave me doxycycline.

I'd just finished the doxycycline when I had to go to the dentist as I was in agony with one of my wisdom teeth (had loads of bother with the one on the other side of my mouth and it was eventually extracted), dentist said he wouldn't look at me without me being on antibiotics due to heart condition so I told him that in the last month I'd completed a course of amoxicillin and one of doxycycline. Dentist said that's irrelevant and gave me metronidazole. I asked if I would suffer any adverse effects due to just being on 2 courses of antibi's and he said no way because they are different types so effects shouldn't cross over.

Thinking that he's more qualified than me (silly really when I did microbiology for 3 years at uni level - really should have known better!) I took the tablets. I've since had a persistant case of thrush which means I've needed a prolonged course of anti-fungals and now have a viral infection which requires me going to see a GUM specialist to try and sort. In the mean time my sex life has went non-existant, I find it hard to "clean up" after going to the loo and I'm bloody embarrased having to get my bits out to every doctor going because apparently this is so rare none of them have a clue how to treat it.

I've been advised to fill in a "yellow card" by one of the pharmacists at work but should I complain? I explicitly told the dentist the start and end dates of both antibiotics and why I was taking them and when I went back after taking the antibiotics he just said the tooth was causing inflammation and that it's normal for uncut wisdom teeth so I didn't need the anti-bis at all (and they didn't help any so not even got that as a consolation). I'm in 2 minds about it, I really like the dentist and don't want to sour our relationship but I feel that on this occasion he's not given me the best care and it's led to all sorts of unnecessary complications.

What does everyon else think?

Toothsmith

I can't understand why the heart condition is relevant?

It used to be that for various heart problems a patient would have to take 3g amoxicillin an hour before treatment.

For about a year now, NICE guidelines have stated this is unnecesary.

But the antibiotic given to supposedly prevent the heart problems was never metronidazole. Which IS given for wisdom tooth problems.

The bottom line though is that no-one is really to 'blame' for an unusual drug reaction, or an unusual fungal infection.

Thrush IS a complication of being on antibiotics for a while, but it usually responds well to treatment. It's just unlucky.

welshdent

Not really sure what the dentist has done wrong? Metronidazole (which is a different drug to both amoxicilling and doxycycline) is a very common drug for wisdom tooth problems especially where an overlying bit of gum gets inflammed. Have you since had the tooth extracted? If not did the metro sort the problem? How else would you have liked this toot problem managed? I cant think of a time I have taken out a partially erupted wisdom tooth in house. I usually refer them on to someone good at it. I CAN think of many times I have given metronidazole for similar problems. Not sure the viral infection would be linked but the fungal infection can be ... but its just as likely to develop from either of the other 2 antibiotics as metro

Kaz2904

The yellow card is not used to report your dentist. It is used to report an unusual drug reaction. The information goes to the BNF and they can see if there is an increase in something happening or if there are life threatening reactions to certain drugs. There are a few yellow cards in the back of each BNF and it has instructions for how to fill it in.
I don't know that a yellow card would be the appropriate response here though as it doesn't sound like a reaction to a drug.

GlasweJen

I did say that the pharmacist gave me a yellow card to fill in.

The dentist gave me the metro when I described the problems, he hadn't even looked in my mouth at that point, he refused to until I had completed the metro course as apparently he couldn't touch me with those problems and a heart condition???

The tooth didn't seem to react to the metro at all, was still agony at the end of the course, I took paramol for a few days and now it's better, still flares up and has sore days but not as swollen as before. Tooth is still in situ, dentist says he can't remove it as it hasn't errupted and that as a last resort I can go to the dental hospital in Glasgow and get it taken out but there's a risk of damage to the teeth beside it which are healthy.

The more I read the more I think he's just decided that antibiotics are the easy answer regardless of my medical history, thrush isn't really the problem it's the problem which is only found in immunosuppressed people which I am not!

welshdent

Well antibiotics are commonly prescribed for unerupted wisdom teeth problems. As for having the extracted, NICE guidelines are generally rigidly followed by hospitals. If you get a condition called pericoronitis then you would need to have had 2 or more episodes of this to warrant extraction for example. In the meantime management of pericoronitis (very common in partially erupted wisdom teeth) may include or be limited to prescription of an antibiotic such as metronidazole and or irrigation of the gum flap to remove debris etc that is building up. From what I can see based on your description the prescription of antibiotics alone is not a cause to complain. The problem that requires treatment at the GUM clinic, if viral is IMO very unlikely to be due to antibiotics. Understandably you havent gone in to much detail on specifics there ... but I can not fathom what could be related to indescriminate use of antibiotics ... also you do not appear to have recieved multiple prescriptions of it either just the one. It would also be normal practice to NOT give the same family of antibiotics more than once in a month. Now I can not comment on him not examining you nor could I begin to comment on the idea he can not look at you with this heart complaint. NICE have changed their guidelines on antibiotic cover for interventions .. and we do not need any now.

So in summary ... antibiotics ... can be the first choice for management for wisdom tooth problems if it is pericoronitis. He has only given you them once so that doesnt sound indescriminate use. The easy option would be to refer you ... really. Send you to the hospital and have them deal with it is by far and away the easy option. Have your docs said that the metro has caused any of your problems specifically? Are they investigating to rule out any underlying undiagnosed problems you may have? I can see that you are unhappy with your management but perhaps this is more of a communication issue than clinical management?

welshdent

Nice guidelines for wisdom tooth removal http://www.nice.org.uk/nicemedia/live/11385/31993/31993.pdf

Toothsmith

There is too much here that makes no sense whatsoever.

The antibiotic prescribing sounds perfectly reasonable for the conditions as described.

A dentist being cautious of a heart condition would have been happening 18 months ago but not now (So a dentist a bit 'behind the times' is possible) But even then, a weeks supply of metronidazole was never a recommended way of dealing with such problems.

Metronidazole though, is a perfectly acceptable way of treating a wisdom tooth problem.

Three courses of antibiotics, of different types, for 2 different problems doesnt usually cause problems. If it has, then why is it the dentist's antibiotics that you're blaming, just because they're the last ones? It would be the initial amoxicillin for sinusitis that I would say was the most inappropriate prescription - sinus problems should have doxycyclin right from the off.

Antibiotics wouldn't have caused a viral gum problem.

Thrush IS a problem of immunocompromised people - but it is also a side effect of long term antibiotics. But it doesn't usually cause major problems and is usually easily treated.

So, I say again, I don't think, from what you report, you've been treated badly - but there are a lot of inaccuracies in your report. So either someone has been explaining things badly to you, or you've not understood things properly.

donteatthat

I don't see how you having a microbiology degree makes you better qualified in the appropriate use of antibiotics than those who have dealt with you - it just sounds a bit arrogant (without wanting to sound rude although I appreciate you are upset at your current GU issues) and it would appear to me that the antibiotic doses are not excessive and would not cause a problem for a normal, healthy person. Obviously you will know that doxycycline is not that useful for dental infections with your degree........and I would agree with TS that amoxicillin is usually pointless for sinusitis. Amoxicillin however boys is considered to be preferable in the management of pericorinitis than metronidazole from my FGDP prescribing guidelines.......
I've never heard of anyone getting an opportunistic GU viral infection as a result of the antibiotic regimes you have been given, but thrush is a common outcome - and easily dealt with.
The yellow card is of little benefit here as they are not for complaining about doctors or dentists - and what adverse reaction are you reporting? You don't catch a viral infection as a result of antibiotics to treat a bacterial one. It is more likely that your current health problems are more to do with your current immune status over and above any antibiotics prescribed to deal with the symptoms. Metronidazole however can cause a transient neutropenia, particularly a problem for those who are already immunosuppressed so perhaps your immune status warrants more investigation rather than trying to blame the antibiotics (or prescribers).

sooz

I think the OP meant genitourinary medicine specialist for the thrush, not a tooth & gum specialist

welshdent

donteatthat wrote: »

I Amoxicillin however boys is considered to be preferable in the management of pericorinitis than metronidazole from my FGDP prescribing guidelines.......
.

I bloody hate guidelines LOL. I did my MFGDP exams last year and yeah ... one lot would say that then another book metro. Joys! LOL. I find both work quite well in practice though in my hands .. so too corsodyl ... as long as they dont freak at the "needle" from the monoject