Bactrim vs. Levaquin (sp?) vs. ???

[ALCapshaw2]

Surgeon worked me in this afternoon.

Cyst is infected. Wants to start anti-biotic TONIGHT.

Offered Bactrim or Levaquin (sp?) or whatever

Local Coumadin Clinic Nurse said Bactrim has less effect on INR.
Local Pharmacist said Levaquin has less effect on INR

HELP! I need a tie breaker, or better yet, someone who REALLY knows the best option.

The ONLY thing that everyone seems to agree on is that any anti-biotic that will be EFFECTIVE ... WILL increase INR.

INR was 3.9 today. CRNP advised to take 3 mg tonight instead of usual 4 mg, then resume standard dosing.
Scheduled another INR test for MONDAY.

What do you think of reducing dose by 1 mg each day?

FRIDAY, the surgeon will LANCE the cyst while still anti-coagulated.

'AL Capshaw'

 

[Rich]

Al,
I don't know which has the least effect on one's INR, but I have taken both of those at one time or another.
During those times I simply increased my intake of vit K, ate salads, cole slaw, etc.
It worked very well and i never went out of range.
When I had diverticulitous they put mr on two VERY strong anti-biotics at the same time. Again I just took in a lot more vit K and had no problem.
Rich

 

[DrAllan]

Al,

Your simple straightforward question brings up a whole host of questions and problems regarding infectious disease. What the problem comes from is because of the nature of antibiotic resistance. Right now without a culture of the organism one is picking an antibiotic on purely empirical guessing. I the ?good old day? before this resistance you would probably get the newest, most expensive, ?broad spectrum drug.? Now the particular bug you have may be resistant to the high powered third generation drug and sensitive to an old line drug. In this case the Levoquin is ?new? and Bactrim (in the family of erythromycin) is ?old?. Thus clinically, one chooses on the basis of what is common infection in the community, statistically what the type of organism it is likely to be (my guess staph or strep). One starts a trial of medication and looks for results. If the infection starts resolving then stick with the Rx. If it stabilizes but does not improve then perhaps guess on another antibiotic. (The crucial word here is GUESS). If it gets worse then it is a clinical decision whether to again guess on antibiotic and/or lance the lesion to get a culture as well as adhere to a time tested surgical maxim of draining an infected lesion.

Incising the infected lesion significantly changes the future management. Ther will initially be new forming scare around the cyst and operating on this is equivalent to operating on Jell-O. On needs to wait 6-8 weeks for the inflammation to calm done and then there is scar holding the cyst in place. This tends to rupture more easily when removed an as opposed to virgin cyst, does not shell out easily.

Now to your real question. The effect on your INR is not only mostly a result of your body?s response and metabolism. I am not aware of any studies showing a measurable statistically valid difference.


This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

 

[ALCapshaw2]

Incising the infected lesion significantly changes the future management. There will initially be new forming scare around the cyst and operating on this is equivalent to operating on Jell-O. One needs to wait 6-8 weeks for the inflammation to calm done and then there is scar holding the cyst in place. This tends to rupture more easily when removed an as opposed to virgin cyst, does not shell out easily.

OH BOY, this REALLY creates some confusion about the next couple of months.

I just POSTPONED my tentatively scheduled MVR (OHS#3) because I wasn't 'ready' among other reasons. AS it turned out, that was probably GOOD because my sinuses were RUNNING, throat was RAW, I was Coughing and Sneezing (can you imagine THAT in the ICU???) and then this past weekend the cyst flares up (again), in the same spot where I had one excised 20 some years ago.
Guess I needed to add a little EXCITEMENT to my life!

SO, the 'Elephant-in-the-Room' Question is:

When to have MVR? February is VERY HEAVY workload for my S.O. (Taxes), Surgeon is going on vacation in March, and my Mitral Valve Gradient is 20+ at rest but 50 mmHg after walking 6 minutes on a treadmill (Bruce Protocol). EVA is 1.5 cm sq.

Hope I can hang on until April (and get this infection cleared up !!!

'AL Capshaw'

 

[DrAllan]

Al;

There is no elephant in the room re the cyst. Get infection under control and leave in place and take care of MRV. I cannot address the timing of the MRV but suspect that waiting may not be a good idea. (this IS the elephant) The recurrent cyst has been there a long time and only recently became infected. I bet if you think back you have probably been rubbing or squeezing the site for a while


This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.