The Dude Abides said...
Please try not to "Quote Post" the entire message, as it will become difficult/impossible to read.
Currently, I'm struggling with whether or not to take a Z-Pack -- five days of the antibiotic Azithromycin (Zithromax). I'd appreciate any feedback that folks are willing to offer.
SUMMARY said...
Been dealing with a cold, sinus infection, or something similar for 11 days. Had a bad sore throat, thought it was strep, but I tested negative. Throat now better. No fever. Until today, no real coughing of which to speak. Now a mild cough that seems to be progressing. The cough is largely unproductive. When it is productive, it's usually clear. For the first several days, sinus drainage was mostly clear and sticky. It then turned a bit yellow. Now, it's mostly clear again. If blowing my nose with enough force, following a steaming shower, darker, sticky mucus is sometimes ejected. Early on, my ears were plugged. Now, they seem pretty much back to normal. My sense of taste and smell were diminished one day, mostly gone the next day, and now seem a bit improved. Despite my still-diminished sense of taste and smell, I do constantly smell what I would refer to as "sickness" or "infection" in my sinuses. A Physician Assistant prescribed five days of Azithromycin, but most cold/flus are viral. Antibiotics aren't intended for viruses. An MD said I could take Azithromycin, Amoxicillin, or neither. I don't want this to linger on and perhaps turn into a bacterial infection. At the same time, I don't want to take a medication that I don't need or that's not effective or appropriate. In a GI-MAP test, several years ago, "C. difficile, Toxin B" was detected, though I was asymptomatic. One of the concerns noted in the Azithromycin package insert is C. diff infections.
LONG VERSIONFor about
11 days, I've been struggling with a cold, sinus infection, or something seemingly along these lines.
The first symptoms were sinus congestion and pain behind my left eye. When I would blow my nose, I had stabbing pain in my temples for a few seconds. I also heard squeaking in my ears, as the pressure tried to equalize.
Then, in the following days, I developed a scratchy throat that progressed into the worst sore throat I've had since relapsing in 2013. I thought it was likely strep throat, but I had a strep test and the result was negative. I also had swelling in my throat that felt like I had swallowed a golf ball.
about
two days later, my throat was nearly back to normal. The sinus pressure was somewhat improved, but when I would blow my nose, the squeaking in my ears continued.
When blowing my nose, the result has mostly been clear discharge. It's also seemed quite sticky. Only after several days from onset did I get a bit of yellow discharge from my sinuses.
For the last couple of days, after 15-20 minutes in a blazing-hot shower and inhaling the steam, if I would blow my nose with as much pressure as I could muster, I would discharge some darker mucus. Again, it was sticky.
Christmas Eve (Saturday), it seemed my sense of smell and taste were diminished. On Christmas (Sunday), I couldn't really smell or taste anything. I was also much more tired and fatigued than usual.
Monday (December 26th), I felt a bit better, though the lack of smell and taste persisted. Tuesday (December 27th) was about
the same, most of the day. By evening, I began to develop a bit of a cough.
(It's currently 3:15 AM Eastern on Wednesday, as I write this. I've not yet gone to sleep for the night.)
Prior to Tuesday, I'd not had any cough. At times, though, I would force myself to cough, in order to see if I had any rattling in my chest. Initially, I had none. Then, a few days later, I had a little. The discharge has been clear, the vast majority of the time.
I didn't keep notes on symptoms or timelines, so the above is my best reconstruction from my terrible memory.
Along the way, in order, I took over-the-counter medications:
Advil Allergy and Congestion ReliefMucinex Fast-Max Severe Congestion & Cough (even though I didn't have a cough)
Walgreens Mucus Relief PECurrently, I'm only taking the Mucus Relief PE.
Thankfully, as of this writing, I've not had any fever during this event.
Last week, in anticipation of the Christmas weekend, a Physician Assistant (PA) at the Veterans Administration (VA) wrote me a prescript
ion for the Z-Pack. It's five days of the antibiotic Azithromycin. He wanted me to have it, since the clinic would be closed. He said I should take it, if I started coughing up colored mucus.
However...
Since then, I spoke to a few Registered Nurses and one Medical Doctor through the VA.
One Nurse said Amoxicillin is typically prescribed for sinus/respiratory infections, whereas another Nurse said Azithromycin is more broad-spectrum and should also be fine.
When speaking to the MD, via telephone, he said either antibiotic is fine. Given that it had been seven or eight days that I'd been dealing with this, the MD suggested I take the Z-Pack. Or, he would call in a prescript
ion for Amoxicillin, if that's what I preferred. (If *I* prefer? Who's the doctor, for Pete's sake?)
After expressing my hesitation about
taking antibiotics for what could be a viral illness and not a bacterial issue, the MD said I was right and I didn't have to take any, if I didn't want too. (silent eye roll) I asked if there was a way for us to test the mucus I was discharging to determine if it's bacterial or viral, but he said "No." If I'm not mistaken, I think he also stated that even if this is bacterial, my immune system should clear it anyhow.
So, with the varying medical opinions, the improvement of some symptoms and progression of others, the length of time, concerns about
this progressing into something worse, the uncertainty if this is viral or bacterial, the concerns of
C. diff that's mentioned in the printout from the pharmacy (I did get the prescript
ion filled and had planned to take it, but reconsidered and got stuck in "Analysis Paralysis"), and having "C. difficile, Toxin B" identified in a
GI-MAP test several years ago, I'm not completely sure how to proceed.
I've spent way too much time in my own head spinning my wheels with this decision. It's probably not a big deal, either way, but this just seems to be what I need to do, in order to gather enough data and opinions until I'm utterly exhausted and make a decision out of exasperation.
My thanks and appreciation for anyone who suffers through this brain dump.
Dude
p.s. The CDC website has
this infographic showing that antibiotics are NOT needed for Common Cold/Runny Nose, Sore Throat (Except Strep), COVID-19, or Flu. Even for Bronchitis/Chest Cold, they suggest antibiotics aren't needed, "in otherwise healthy children and adults." They show Middle Ear Infection and Sinus Infection as a "Maybe." Only Strep Throat, Whooping Cough, and Urinary Tract Infections garner a solid "Yes" for antibiotics.
Duke University published
Is it a Bacterial Infection or Virus? which suggests that 14 days may be the point at which to consider the infection may be bacterial.
_I've tried z pack and made me feel worse or the same. It worked only when I needed when we actually have an infection not bacterial. Had to take it because I had a cold with really green mucous and phlegm that was green so obviously it helped get rid that .