Ear Infection + Antibiotics = INR?

[Lisa in Katy]

Last Saturday I woke up with a very sore throat. It felt kind of "streppy" but since I couldn't find a doctor open on Saturday and didn't really want to pay $250 ER deductible in December, I treated with Tylenol & Sucrets. Sunday morning, my throat was still a little sore, but not bad, so I was glad I didn't go to ER. However, by mid-afternoon, my ear started hurting, and by that evening, I could hardly stand it - much worse than post-surgical pain! So, I went to doctor Monday morning and she prescribed Z-Pac for bacteria and Vioxx for the pain (I risked a couple of Advil that morning because the Tylenol was doing nothing, of course!). The pain lessened and turned into shooting pains, but I couldn't hear anything in my right ear. So, FP referred me to ENT who said I had blood blisters on my eardrum and severe fluid build-up behind eardrum. He said the blood blisters were probably a combination of infection and Coumadin. He performed a Myringotomy - punctured eardrum and sucked out pus! - and put me on antibiotic eardrops as well as a different oral antibiotic - Robicef, I think.

Anyway, when I called Coumadin clinic prior to procedure, they said to cut my Coumadin in half while on the Z-Pac and then come in for testing on Monday (tomorrow). Since I started a new antibiotic on Saturday morning, I will call them tomorrow to see what they want me to do now. At this point I am assuming that I should still cut my Coumadin in half, but not sure if an INR would be indicated until I'm off the antibiotics, which will be the end of the week.

Ahhhhh......isn't life grand?

 

[LUVMyBirman]

Hey Lisa,

Nice to see you!

Boy, that sounds like a nasty. ENT has you on the right track.

Don't agree with your Coumadin clinics advice to cut your dose. Find more so than not my INR will decrease when on Zpac and a few other antibiotics. If your INR is a bit elevated..may be from the Advil alone. Would be easier to cut your dose if your results come in high.

As you are aware...guessing is a crap shoot and usually throws you further off base.

Do what you feel comfortable doing and keep us posted.

 

[Guest]

Z-Pak drive Coumadin clinic people crazy. It usually causes a huge increase in the INR. But a few people get little or no effect - maybe they do not absorb it well. Then it stays in your body for 5 days after you stop it. This makes it almost impossible to manage.

What worries me is that someone with a valve who suspects strep would not go to the ER right away. I know that $250 is a lot in Dec, but endocarditis etc from strep is not worth it.

 

[Lisa in Katy]

Actually, the second antibiotic I'm on is Omnicef.

If my throat had still been extremely sore on Sunday, I would have gone to ER. It's not unusual to wake up with a sore throat in the winter - indoor heat and all that. I know that in general, 24 hours with strep is acceptable, even to someone with a mech valve. In fact, most literature states that it helps your body build antibodies. So, I'm not stupid, but I am frugal!

 

[Guest]

Antibodies develop upon exposure to viruses.

Strep is caused bacteria

Bacteria do not cause antibodies to develop.

 

[Nancy]

If I thought Joe was getting anything remotely resembling strep--he'd get whisked off asap.

His whole long, complicated and very serious heart history is from strep that was untreated and turned into rheumatic fever.

His life sure would have been easier without having that.

In addition, rheumatic fever never leaves your body and can reactivate, given the right circumstances.

Valvers, please watch every sore throat. It's just not worth the risk. The minor expense of getting a strep test done is nothing compared to a lifetime of medical difficulties.

 

[LUVMyBirman]

In the past my GP would not hesitate to call in an RX sight unseen if she even suspected I have strep throat.

Sitting in a ER waiting could make us a whole lot sicker. If the office is open... they do one of those quick tests...and grow it for two days. Even if the first one is negagtive, they usually put me on the antibiotic to air on the side of caution.

As Al stated, can't be too careful.

 

[Nancy]

One of my grandsons is susceptible to strep and ear infections. His pediatrician can do a test on him and have pretty instant results, no waiting for it to grow. Then he gets on antibiotics fast.

 

[Lisa in Katy]

Al, I have to disagree regarding antibodies only being associated with viruses. The following quote was taken from an article regarding recurrent sore throats and how to determine if they are strep or viral in a person who is a strep carrier. It mentions strep antibodies and even says that antibiotics suppress antibody rise.

"In addition, antibody levels need to be drawn when the patient has a sore throat and then drawn again four to six weeks later to measure strep antibodies. If antibiotic therapy has been given to treat prior symptoms, it may suppress the antibody rise, thereby negating the usefulness of this test."

Now, I tend to be laid back regarding my health and it hasn't failed me yet. My rheumatic fever was from a missed diagnosis, but I did go to the doctor. I don't believe that a 24-hour delay of diagnosis will result in catastrophe, and that is why I chose to not go to the doctor immediately. In my case, my recent problem was caused by staph, not strep, which is also treated with antibiotics, and just to be safe, my doctor treated me with an antibiotic that will fight both bacteria. You all do what is comfortable for you, and I will do the same.

 

[Blanche]

Isn't life grand?

Isn't life grand?

The great thing about this site is that you get the information and you make your decisions about what you believe is best for you. I'm sure that everyone here is very happy that the outcome of your recent choice is a positive one for you.

But, as the spouse of one who could have lived his entire life without MVR (October 1990) except for endocarditis caused by a STAPH infection, I would not recommend your choice to anyone who values the quality of their life....or, actually, their life period...

Let me get this right. You did not seek medical assistance on Saturday, but you "risked taking a couple of Advil." Then on Monday, two days later, the doctor "punctured eardrum and SUCKED OUT PUS!" But, it is important to know that your "recent problem was caused by STAPH, not strep." That's about as logical as paying the Cannibals to eat you last and hoping they will be full before they get to you. If my husband had your symptoms, the only way our comfort levels would have allowed him to wait until Monday for medical care would have been if we were both deceased or brain dead.

Whoever said hindsight is 20/20 was mistaken.

With the kindest regards,
Blanche

 

[Lisa in Katy]

Actually, my eardrum wasn't punctured until Friday, almost a week later, and that was because I couldn't hear. The fluid will stay in your ear for 3-4 weeks after an ear infection is cleared up and it was driving me crazy. I started taking antibiotics that would fight both staph and strep on Monday morning - about 48 hours after I awoke with a sore throat on Saturday. As I said previously, when I woke up Sunday morning, I felt much better. Otherwise I would have gone to the ER then. I never did run a fever. I don't believe in going to the ER everytime my throat is sore - that would be a misuse of medical services in my opinion. When I have a cold, I often wake up with a sore throat, especially when the central heat is running in our house - caused by breathing through my mouth instead of my nose. I didn't say that staph wasn't dangerous - I was in healthcare long enough to know better - MRSA (a super duper staph infection) is one of the most dangerous things in hospitals now, and is starting to spread to the community at large, primarily because it is resistant to most antibiotics. I just made that comment to clear up the fact that I didn't have strep, but staph, something that is much more common, especially in schools, which is where I work now.

Now I know why I rarely post on this site - too many attacks from people who don't have a clue. I am still waiting for an acknowledgement from Al that strep antibodies do exist. Please remove me from the list of the "Magnificent 7." Thanks.

 

[Lisa in Katy]

Oh, and Merry Christmas to all my friends!

 

[Guest]

I will retract that statement - somewhat. Antibodies do play a role in allergic responses also. You do make them in response to bacterial infections. However, I do not know of any proven recommendation to withhold antibiotic treatment to strengthen the immune system. I have no doubt that you could find it in a book somewhere - but remember that we have freedom of the press. There is no censoring board that detrermines truth before a book is printed.

I was recently looking at a book about reversing multiple sclerosis. There were lots of statements in it that were backed up by footnotes. So I decided to read the references. There were many things about cow's milk and diabetes, dental fillings (she never had any), vitamins C and E etc but the only reference to multiple sclerosis was another book. There was not one reference to an actual study done on multiple sclerosis. Nor was there any case in the book (other than the author who claimed to have self-healed). The author was unable to cite one case where another person was healed using this method. This is why I don't believe many statements "strengthening the immune system". There is also always a list at the end of the book where you can purchase these wonderful products. I always wonder why, if these things actually work, hasn't some large company bought out these small, independent dealers and made them available in every discount store in the land. There is usually some conspiracy theory involved.

The reason that it took a long time to respond is that I have been traveling for Christmas and have not had the opportunity to log on for several days.

 

[NascarfanMary]

I woke up this morning with a terrible cold. I am very congested. I have left messages with my surgeon and cardiologist to call back. My son has a the flu for 2 days and I think I may have it. I am very worried about what to take since I have just started coumadin and and just had the valve replaced in Dec. I was having problems with my INR and yesterday it was finally at 3.4 and I felt good till late last night. I hope it is not puemonia or infection. I feel pretty bad. My body aches. Does anyone have a suggestion till I hear from dr?

 

[Guest]

Go to the ER.

You are still in a pretty fragile state.

Don't take any chances.

 

[NascarfanMary]

AL,
My cardiologist syas that they only thing to do is take tylenol and robitussin cough syrup and let the flu take its course. If not any better by Monday go the family dr. I am worried that my coumadin level will be affected by this. I am worried that infection has set in my new mechanical valve the shoulder pain is severe and with my pace maker, there is a greater chance of infection setting in. I thought the dr would give me something to take. I have a very bad feeling about all of this. My family dr. will be on friday. By then I could be worse. Thank you for your help.

 

[Guest]

Any firther recommendations would exceed my knowledge as a pharmacist. I can help people with drug problems and sdvice on when to seek further help, but you have gotten to the limits of my expertise. Sorry!

 

[Nancy]

Hi Mary-

Maybe you should call the surgeon's office and get some input from him. If you don't get any satisfaction there, then do go to the ER. I agree with Al. This soon after surgery, your immune system could be lower than normal and you could be susceptible to things you wouldn't ordinarily be.

Please don't take any chances. It's always better to be safe, especially right after surgery.

Joe has had some pretty weird things happen right after surgery, and some of them have been very serious. Don't want to scare you, but don't let it ride. The weekend is coming up and then you'll be on your own, except for the ER.

Let us know how it goes.

 

[NascarfanMary]

Hey gang,
Just wanted to let you know that I am feeling better. My chest isnt as congested. My home health nurse said that my lungs were clear and my cough is about gone. I slept alot for a few days. My Dr. said that the flu just has to take it course. I am better. But my coumadin was at 3.85 Friday. It has to be the cough syrup I had taken. I guess. These crazy levels are very annoying. Now I take a 5mg and 2 mg this week and have labs on Friday. I know that certain medications work against the coumadin and of course I take one of them. Dilantin for seizures and then having the flu didnt help. But I just wanted to let you I appreicate all your advise. I love the website and have learned alot. Best wishe to everyone.

 

[Guest]

Never be upset by a 3.9 INR particularly after you have been sick. Adjusting the dose in this situation will probably make the INR go back below the desired range. The range is a guideline. Think of it like driving a car. The likelihood of having an accident because of driving 39 in a 35 zone is about how likely you are to have a bleed because of an INR of 3.9. Sure, if it stays there for several months, you might want to tweak the dose down a tiny amount (maybe 1/2 pill per week) but do not panic. You are better off being 0.4 units high than 0.4 units low.

Glad you are recovering.