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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13338
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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Antibiotics

Resolved Question:

Hi Dr. Thomas. I'm scared to death right now. I had 2 wisdom teeth out by a not so great dentist. I was bleeding for hours after. My GP put me on clindamycin. I was not told about the black box warning. I read it and called him back, sadly he was away. I called the dentist and asked for a different drug. He put me on erythromycin. I ended up in the ER with an swollen face and terrible pain.,a PA convinced me to go back on clindamycin.

It felt like my intestines were twisting around. I felt miserable but forced myself to keep taking them. After about 4.5 days I begged my doctor to take me off them. He agreed the symptoms are bad, so I tried penicillin. It turns out I am NOT allergic after all! But he thought it wasn't great to do 3 different antibiotics, but I feel human again.

He put me on a really high dose even though a new dentist thought my mouth looked great. Now I'm terrified to take the rest of the penicillin. I have been a tad nauseous now and again, rare brief shooting pains (mild, lasts for just a second) but no diarrhea. I do have mild stomach aches now too.

Here is the timeline:

Sep 1:one clindamycin 150 mg
Sept 2: erythromycin for 2.5 days, not sure of dosage
Sept 2: clindamycin 300 mg one day, down to 150 mg 3 days
Sept 4: penicillin 500 mg every 6 hours. Still taking it till sept 10

Please tell me what's the worst thing that might happen here. Is this totally dangerous, or do patients do okay switching like this?
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. D. Love replied 1 year ago.
Dr. Thomas is currently not online, so the system has opened the question to the other medical experts.
Would you prefer waiting for Dr. Thomas to be online (he is typically on every day)?
Or would you rather receive assistance from another expert now?

Customer: replied 1 year ago.
Dr. love sounds fine. Please answer.
Expert:  Dr. D. Love replied 1 year ago.
Very good.

There are several levels of answer to this question.

When you ask what is the worst that can happen, this can be taXXXXX XXXXXterally, in which case you will be scared to take any medicine, or the answer that doctors will typically provide is what is the realistic risk with certain medicines and combination of medicines. If you really want to know the worst that can happen, regardless of how rare it is, let me know, but these worst things are extremely rare.

From the perspective of realistic risk, taking this many antibiotics as you have taken is not a significant risk and is certainly not totally dangerous. There are many infections in which we routinely prescribe two and three antibiotics at the same time. Taking three antibiotics sequentially would carry less risk than taking them at the same time.

The primary risk of taking these three antibiotics in the sequence that you describe is the side effects of each respective antibiotic. The primary risk that is unique to using multiple antibiotics in sequence or together is a greater risk of killing good germs, such as the good germs in the gut. It is the killing of the good germs in the gut that can lead to the C difficile infections that are noted in the black box warning. However, as was probably explained to you by the PA, the likelihood of C. difficile when using these antibiotics orally is quite low, including with the clindamycin or with using each of the three antibiotics in the sequence in which they were taken.

To say that the risk is low does not mean that the risk should be completely ignored. It is appropriate to support the growth of the good germs with a probiotic, as you are doing, and to monitor for any early symptoms to suggest that a problem may be starting, so that you can be checked quickly. But the fear of getting C. difficile infections from clindamycin or this combination of antibiotics should not preclude the use of the antibiotics for a bone fide infection. Antibiotics should not be used frivolously, but when there is a true need for antibiotics, you should not be afraid of them.

Therefore, the realistic risk of taking these three antibiotics in the sequence that you describe is minimal, and there is no reason for concern, although it is appropriate to continue the probiotics and to contact your doctor should you develop any worrisome symptoms.

If you have any further questions, please let me know.

Customer: replied 1 year ago.
I can't tell you how grateful I am for the reassurance. I've hardly slept for 4 days!

So would you say C. difficile is the primary risk? Are there other common risks with switching antibiotics? You are right in skipping the rare side effects. I guess I should just hear the common scenarios.

If it's almost always just a risk of c difficile, then I'm okay with that. I heat most healthy adults, non-hospitalized only get mild cases?

Thanks again.
Expert:  Dr. D. Love replied 1 year ago.
In reality, the risk of killing the good germs and causing non-specific diarrhea is seen far more often than C. difficile. An infection with C. difficile is the most worrisome, as it can get severe and will frequently need specific treatment, but we seen non-specific diarrhea far more often. So its not that it is always the small risk of C. difficile that can happen, but it is what would cause the greatest concern.

Yes, most healthy non-hospitalized patients do not get infections, and when infections occur, it typically is milder than when C. difficile infections happen in the hospital.

The only other risks of switching antibiotics is the individual risks associated with each antibiotic. For example, the largest concern with most antibiotics are various allergic reactions. If we can successfully treat an infection with a single antibiotic, then there is only the risk of allergy to a single drug. But if three different antibiotics are used, then there is the risk for each of the three antibiotics. Therefore, there is a greater risk than for any one of the antibiotics, but the risk for each antibiotic is not any greater because another antibiotic was recently used. So, the risk of each antibiotic will add together, but the risk of multiple antibiotics is not greater than the sum.

Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 13338
Experience: Family Physician for 10 years; Hospital Medical Director for 10 years.
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