So…I’ve been struggling this season with allergies and asthma, which have screwed up many of my races. My allergies have manifested as very dry and inflamed sinus tissue, not congestion. For that reason ENT/Allergist suspected that I may have a low grade lingering staph infection deep in my sinuses that flares from time to time due to pollen/mold (no culture or anything like that was done to verify). So he gave me a prescription for clindamycin - which I’m now on my third day of taking.
His instructions were to make sure to take some probiotics (anything off the shelf would do), and to feel free to stop the clindamycin if the side effects started to bug me too much. So I started the clindamycin, and so far I’ve been tolerating it fine - a bit of heartburn is the only real issue. I picked up some probiotics, but haven’t started them yet. I have been eating sauerkraut and drinking kombucha, but not sure how much of a difference that makes.
As I do more reading (especially here), I get more concerned about the clindamycin, and the need for probiotics, and realized that I need to be taking this more seriously. I know that different probiotics have different bacteria - does anyone have any insight as to which bacteria I should be aiming for to balance the effects of the clindamycin?
Any probiotic over the counter would do. Clindamycin targets a lot of bugs that are commonly found for ear, nose, throat, and skin infections. The probiotic you take will stay in the gut and clindamycin will not have as much of an effect on it.
Any probiotic over the counter would do. Clindamycin targets a lot of bugs that are commonly found for ear, nose, throat, and skin infections. The probiotic you take will stay in the gut and clindamycin will not have as much of an effect on it.
A recent report based on a compendium of meta-analysis on rhinosinusitis , called the ICAR (international consensus in allergy and rhinology), revealed that 92% of cases of rhinosinusitis are caused by viral or allergic causes. Pathogenic bacteria in only 8% (of which all do not require antibiotic therapy). As far as your doctor suspecting a lingering staph infection, he may be referring to the fact that between 5-10% of the population carry resistant staph organisms in the nasal vestibule; the treatment to eradicate this is daily use of a topical ointment called mupirocin, which is not systemically absorbed. I imagine that if you have been evaluated by and ENT there may be more to your story. Have you had nasal/sinus surgery ? Do you have a history of nasal polyps ? Do you have a diagnosis of allergic fungal sinusitis ? Have you had a recent CT scan and/or nasal endoscopy in the office ?
Int Forum Allergy and Rhinology, vol 6, suppl.1, Feb 2016.
That is crazy that your practitioner is having you take the antibiotic without any confirmation that you are actually suffering a bacterial infection.
The drugs have very significant side effects. I would very seriously consider getting a new practitioner.
I was surprised too, especially after I did more research, due to my past GI history.
He did say that in his experience that sometimes the infection was difficult to confirm by culturing/sampling - just too deep in the sinuses. And I’ve had similar symptoms (excessive dryness in the sinuses) before in allergy season. I can’t speak for him, but I don’t think his general response is to hand out antibiotics left and right.
I will also note, in his favor, that the sinus issues HAVE improved notably in the past few days. The pain actually flared with the first dose or two (got a splitting headache), and then subsided. Of course, I’m also on a break from training right now also - that could be a factor.
OTOH, part of me wishes I had waited for my appointment with the GI doctor before starting them. But…water under the bridge at this point. I’m on them, and since they’re not causing diarrhea currently, I really don’t want to stop them early. I’ll just hit up the probiotics and talk to the GI doctor on Friday for his take.
A recent report based on a compendium of meta-analysis on rhinosinusitis , called the ICAR (international consensus in allergy and rhinology), revealed that 92% of cases of rhinosinusitis are caused by viral or allergic causes. Pathogenic bacteria in only 8% (of which all do not require antibiotic therapy). As far as your doctor suspecting a lingering staph infection, he may be referring to the fact that between 5-10% of the population carry resistant staph organisms in the nasal vestibule; the treatment to eradicate this is daily use of a topical ointment called mupirocin, which is not systemically absorbed. I imagine that if you have been evaluated by and ENT there may be more to your story. Have you had nasal/sinus surgery ? Do you have a history of nasal polyps ? Do you have a diagnosis of allergic fungal sinusitis ? Have you had a recent CT scan and/or nasal endoscopy in the office ?
Int Forum Allergy and Rhinology, vol 6, suppl.1, Feb 2016.
You should be in good hands then. Dont get too excited about replacing natural flora or negative GI side effects unless you’re on an extended (21day) course of antibiotics. Consider use of mupirocin topical ointment and a nasal wash with Alkalol (not alcohol) to help hydrate the lining of your nose. Antibiotic choice is often based on your known allergies and regional differences.
Sounds like you may have eosinophilic esophagitis/ gastroenteritis, an allergic condition seen with many of your related symptoms. Avoidance of known and suspected allergies including foods is important.
Anti-inflamatory treatment could be suggested by your GI doctor as well as histamine (H2) blockers or proton pump inhibitors.
SO you know, your improvement on clindamycin may be due to the well established but not so well understood anti- inflammatory (not antibiotic properties) of this drug.
I would not worry about the past GI issues you described with clindamycin.
As an antibiotic, it is great for ear, nose and throat issues. The side effect of also treating your natural GI flora puts you at risk of Clostridium dificile growth. They secrete a toxin that causes C. diff colitis. The colitis itself is treatable as well, but generally not something you want. Let your doctor know if you notice loose or malodorous stools.
The probiotics and various other foods with bacteria are intended to keep colonization with the bacteria that normally inhabit the colon.
ID (infectious disease) guy here. Everyone responds differently to antibiotics. Clindamycin is very broad spectrum (i.e. it targets a lot of bacteria which include gram positives that are typically skin bacteria like staph and gram negatives that are normally in your gut). I have patients who are on clindamycin indefinitely with little to no side effects. I also have patients who can barely tolerate more benign antibiotics (i.e. less broad spectrum).
I don’t disagree with your doc. Differentiating chronic sinusitis due to allergies vs bacterial is very hard and often times it’s both. Antibiotics are generally started on based on history and physical exam. There isn’t a test as some have suggested. It’s especially bad this year due to bad allergy season.
Regarding probiotics, the studies are limited/mixed from what I’ve read. Why? Mainly because there’s not a lot of money out there for these studies (i.e. big pharma not involved). I tell my patients that it doesn’t hurt except a couple bucks. Yogurt has probiotics too. Pills and foods like yogurt have different types probiotics. Once again there’s little evidence on what’s best so don’t worry too much about which one to take. Just make sure you take it at least 2-3 hrs from your clindamycin otherwise the clinda will just kill the probiotics.
Someone mentioned c diff, which I’m guessing you have very low risk factors. Risk factors include frequent healthcare exposure, frequent antibiotic exposure, work as a healthcare professional, or in contact with someone with c diff. Just like the doc know if you have 3 or more episodes of watery diarrhea, not loose BM.
Hope your sinuses clear up so you can train/race well.
Hi all - thanks for your input. In case it’s helpful to others who search this forum in the future, I’ll report on my appointment with the GI doctor today.
For the past few days, I’ve been taking two probiotics: Florastor (Saccharomyces boulardii CNCM) and Phillips’ Colon Health (Lactobacillus gasseri KS-13; Bifiidobacterium bifidum G9-1; and Bifidobacterium longum MM-2).
He said that I should continue taking the Florastor while taking the antibiotic, but should hold off on the Philips until I was done with the antibiotic - the Philips is apparently being killed by the antibiotic, even if I space the doses apart. No harm to taking it, but no point either. The Florastor isn’t affected by the antibiotic, so good to take it now.