Laurette has been coping very well with AD for 9 years. Until two days ago she was mobile, verbal, alert, continent by day, and healthy. She got an ear infection which was causing some pain and a minor bladder infection simultaneously, so the doctor prescribed an antibiotic for the infections, and tylenol and ear drops for pain.

Once she started on the drugs she went into a complete stupor. She is not responding to language, has a blank unknowing stare, is peeing all over the place, is unsteady on her feet, and is highly fatigued. She understands little, talks less, and hasn't even smiled at the cats in days.

Which is more likely to be the cause of such a sudden change, the drugs or the infections? I suspect the doctor did not take her weight into account when writing the prescription. 500mg of antibiotic and 1000mg of tylenol twice a day is a full size adult prescription and she's only 90 pounds.

I am very concerned about her sudden change. The ear drops seem to be working so I stopped the tylenol, and I am now cutting the antibiotic (clarithromycin) in half. I think this will still treat the symptoms and infections without saturating her system with drugs.

Any suggestions will be greatly appreciated.

I am sorry that this has happened. It is bad enough that our LO's have to go through what they are going through without having illnesses too. I think you have done what I would have suggested. I think you won't see an improvement right away but if it was the medication you should see something different within a few days. I am not a nurse but I have been talking to one and she told me that the results of medication don't stay in the system very long.

I hope everything goes better for your grandmother.

It's not a good idea to cut the antibiotic in half without talking to her doctor. Her behavioral change could be due to the ear infection or uti itself, which may not go away on a lesser dose of antibiotics. I'd call the doctor ASAP, if it were me. It's a holiday weekend, so I'd leave a message on the answering service for him/her.

Please, call and speak with her doctor ASAP!

Take her to the ER. This is a dramatic change. It could be due to a stroke, or to sepsis having developed.

(Never cut the dose of an antibiotic in half. You could easily end up creating a drug-resistant strain of the pathogen. For the same reason, give your loved one the medicine until it is all used up. If you think your loved one might be having an adverse reaction, contact the doctor immediately.)

Update:

After halving the antibiotic Laurette was somewhat more human and less vegetable like, responsive to voices and visual cues, etc. This was encouraging and I stopped it completely about 24 hours ago. She is now completely alert, mobile, and conversant again. Somehow that particular drug sent her into a spin. We will be seeing the doctor again on Monday, but since she already had 6 days of antibiotics I don't feel bad about stopping the medication. She was practically stoned and in another world somewhere so I won't give her any more of this antibiotic. She did not tolerate it well at all.

Always an adventure!

Here's a little update on Laurette's ear infection:

She had 4 days of Amoxocilin and 2 days of the offending antibiotic (clarithromycin) before we stopped it. Theoretically this should have been enough antibiotic, but the doctor put her on a third one just in case. She tolerated the new antibiotic well, but the infection continued to get worse and her ear continued to keep both of us up all night.

The infection has now worsened to the point that medicated ear drops can not reach it due to swelling and pussy discharge. It is very deep in her ear, has worked through the skin layers, and is now infecting her skull bone. I didn't even know this was possible, but it's a condition called skull-based osteomyelitis. It is quite serious and could take months to heal. If untreated it can have severe consequences like deafness or even death, but we caught it early enough that we should be able to resolve the problem eventually. She has seen an ear, nose, and throat specialist 5 days in a row now and he is quite concerned, but we have seen some improvements since we switched from a GP to the ENT.

We can anticipate months of interrupted sleep and painful throbbing in her inner ear. I know that would drive me towards insanity and decrease my level of function considerably, so I'm not sure how somebody with AD will cope. Fingers crossed...

To make things worse, I'll be out of town during August and my mom will be doing the caregiving by herself. She's going to have her hands full.

She could be having a "negative allergic" reaction to the antibiotic,,you need to call the Dr right away....and you were smart to stop the tyelenol,,,that was way too high of a dosage daily. What ear drops is she on ?

Seems that with taking an oral antibiotic she shouldnt really need to use ear drops,,,I know,,due to the fact that I've had numerous ear infections in the past years,,and I am allergic to all penicillian and sulpha drugs.

Please call the Dr,,and tell him about the symptoms that your LO is experiencing,,and also remind the "medical genius" about your LO's weight. Best of luck,hope she gets to feeling alot better really soon,,I know this has you very concerned. Keep us posted. Peace

Different antibiotics target different pathogens. Using one antibiotic for four days and a second for two days is *not* the same thing as using one antibiotic for six days. Taking a patient off one antibiotic after four days and then off a second one after only two days is a really great way to develop drug-resistant pathogens.

Per rxlist.com (Johanna's favorite site for looking up information about drugs):

Amoxocilin:

Precautions: Prescribing AMOXIL in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Indications: AMOXIL is indicated in the treatment of infections due to susceptible (ONLY β-lactamase- negative) strains of the designated microorganisms in the conditions listed below:
- Infections of the ear, nose, and throat - due to Streptococcus spp. (α- and β-hemolytic strains only), S. pneumoniae , Staphylococcus spp., or H. influenzae.
- Infections of the genitourinary tract - due to E. coli, P. mirabilis, or E. faecalis.

Dosing:
- Mild/moderate infections 500 mg every 12 hours or 250 mg every 8 hours.
- For severe infections or less susceptible organisms, 875 mg every 12 hours or 500 mg every 8 hours.

Smaller doses than those recommended above should not be used. Even higher doses may be needed at times. In stubborn infections, therapy may be required for several weeks. It may be necessary to continue clinical and/or bacteriological follow-up for several months after cessation of therapy.

Treatment should be continued for a minimum of 48 to 72 hours beyond the time that the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. It is recommended that there be at least 10 days' treatment for any infection caused by Streptococcus pyogenes to prevent the occurrence of acute rheumatic fever.


Clarithromycin:

Precautions: Prescribing BIAXIN in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.

Indications:
- In children, for treating Acute otitis media due to Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae
- The list for uses in adults does not include infections of the ear or urinary tract

Dosage information:
- To reduce the development of drug-resistant bacteria and maintain the effectiveness of BIAXIN and other antibacterial drugs, BIAXIN should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.
- Dosing for the approved uses/susceptible strains ranges from a minimum of 7 days to as much as 14 days.


Clarithromycin can be used in combination with amoxocillin for, e.g., H pylori infections in patients with duodenal ulcer disease.