Struggling with Antibiotics: What to Do When Symptoms Persist?

What should I do if taking antibiotics has not improved my condition?

Hello Doctor, I have been experiencing nasal congestion and coughing since early September.
Initially, I thought it was just a cold and decided to let it resolve on its own, so I didn't see a doctor right away.
However, during this period, I continued to cough, had nasal congestion with phlegm, and even coughed to the point of vomiting.
On October 11, I went to see a doctor who diagnosed me with sinusitis and prescribed antibiotics, specifically Curam 1G.
The next day, I tested positive for COVID-19, but the doctor still advised me to continue the antibiotics.
However, I experienced diarrhea, so the medication was switched to Cefspan.
After taking it until October 19, I still saw no improvement.
During this time, I felt like there was phlegm stuck in my throat, which was itchy, and I would cough when speaking.
I also had yellow phlegm and yellow nasal discharge, with a salty taste.
On October 20, I visited another ENT clinic where I was prescribed Fuyan Kang for three days, but it had no effect.
The medication was then changed to Rifampicin 300 mg, which I took for about a week, but still felt no improvement.
I then went to the hospital and consulted the ENT department, where I underwent an endoscopy.
It showed yellow nasal discharge and some bleeding in the nasopharynx.
The doctor prescribed Munkangxing, two tablets twice a day, along with a nasal spray (Nesol).
A bacterial culture was also performed that day, and I am waiting for the results next week.
Two days later, I went to the pulmonology department for a check-up.
A chest X-ray showed no issues, and I was prescribed a seven-day course of Colistin, taking one and a half tablets daily.
The doctor advised me to take this medication instead of Munkangxing.
Starting from November 4, I began taking Colistin along with the nasal spray (Tessalon).
On the sixth day, I had a follow-up with the ENT department, and the report indicated two types of bacteria, both of which were susceptible to Colistin and Munkangxing.
The endoscopy showed significant improvement with scabbing present.
The doctor said I would be fine after finishing the medication, so I continued taking antibiotics for another two days before stopping.
On November 18, during a follow-up with the pulmonologist, I mentioned that I still felt mucus and salty phlegm.
The doctor believed it was unrelated to the COVID-19 diagnosis and attributed it to nasal issues.
He prescribed some allergy medications along with the nasal spray (Tessalon).
After taking these for about three to four days, I felt no improvement.
On November 29, I returned to the ENT department at the hospital.
The endoscopy showed no yellow nasal discharge, but it felt inflamed, indicating issues with the sinuses and nasopharynx.
I was prescribed a seven-day course of Clarithromycin and the nasal spray (Aminesol).
After seven days, I still felt I had not fully recovered.
On December 6, during a follow-up and another endoscopy, it was found that the condition had worsened, with yellow nasal discharge present again, although it was not there the previous week.
Since I previously thought Colistin was effective, I was prescribed Colistin again along with Aminesol.
I am beginning to wonder if this is really that difficult to treat.
I have been afraid of taking so many medications; I have never had allergies or sinusitis before and have rarely been sick, usually recovering quickly with just a few packets of medicine.
This experience has been quite frightening for me.

I would like to ask:
1.
What is the difference between Colistin and Fuyan Kang, as they look identical?
2.
Why has my condition worsened again? Could it be that the bacteria were not completely eradicated while taking Colistin?
3.
Is it harmful to continuously take antibiotics like this? Could it affect my brain?
4.
If antibiotics are ineffective after prolonged use, what should I do? How many months should I continue taking them?

Yue Liang Xian Zi, 30~39 year old female. Ask Date: 2022/12/06

Dr. Zheng Jueyi reply Otolaryngology

Hello, Colabital and Vuflax are medications with similar active ingredients, differing only in their brand names.
If symptoms persist without improvement, it is advisable to continue follow-up visits with an otolaryngologist or pulmonologist for treatment.
Antibiotics generally do not affect the brain; if the medication is not effective, the clinician will assess the situation and take appropriate action.

Reply Date: 2022/12/06

More Info

It sounds like you have been through a challenging and frustrating experience with your persistent symptoms and the various antibiotics prescribed. Let's address your questions one by one, while also providing some context regarding antibiotic use and management of your condition.

1. Difference Between Co-Amoxiclav (Curam) and Rifampicin (伏炎康): Co-Amoxiclav, commonly known as Curam, is a combination antibiotic that includes amoxicillin (a penicillin-type antibiotic) and clavulanic acid. It is effective against a broad range of bacteria, particularly those that produce beta-lactamase, which can make them resistant to amoxicillin alone. Rifampicin, on the other hand, is primarily used to treat infections caused by specific bacteria, including those responsible for tuberculosis and some other serious infections. It works by inhibiting bacterial RNA synthesis. The choice between these antibiotics depends on the type of bacteria causing your infection, which is often determined by culture and sensitivity tests.

2. Why Symptoms May Worsen: There are several reasons why your symptoms might have worsened despite antibiotic treatment. One possibility is that the bacteria causing your infection may be resistant to the antibiotics you have been prescribed. Another reason could be that the underlying condition, such as sinusitis or another respiratory issue, has not been fully addressed. Additionally, the presence of inflammation or other factors, such as allergies, can contribute to ongoing symptoms. It's also possible that a secondary infection could have developed.

3. Impact of Prolonged Antibiotic Use: While antibiotics are essential for treating bacterial infections, prolonged use can lead to several issues. One concern is the development of antibiotic resistance, where bacteria evolve to become resistant to the drugs meant to kill them. This can make future infections harder to treat. Additionally, long-term antibiotic use can disrupt the balance of normal flora in your body, potentially leading to gastrointestinal issues, such as diarrhea or yeast infections. However, antibiotics do not directly affect the brain in a harmful way; their primary impact is on bacterial populations.

4. What to Do If Antibiotics Aren't Effective: If you find that antibiotics are not resolving your symptoms, it is crucial to communicate this to your healthcare provider. They may consider alternative treatments, such as different classes of antibiotics, or investigate other potential causes of your symptoms. This could include further imaging studies, allergy testing, or referral to a specialist, such as an allergist or an ENT (ear, nose, and throat) specialist. It's essential to follow up with your doctor, especially if your symptoms persist or worsen.

In summary, managing persistent symptoms after antibiotic treatment can be complex. It's vital to work closely with your healthcare providers to identify the underlying cause of your symptoms and to determine the most appropriate treatment plan. If you feel that your current treatment is not effective, do not hesitate to seek a second opinion or ask for further evaluation. Your health and well-being are paramount, and addressing your concerns with your healthcare team is the best way forward.

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