Back in the first week of July my toddler put a small battery in her nose. Despite doctors examining her and a three day stay it was in her nose for exactly three weeks before her father and I figured it out. As a result she was on Amoxycillian most of July. The Ent doc prescribed a penecillian my child could not keep down. We bought Azithromycin as a subsitute. Yesterday was the ENT follow-up. The doc spoke English so I felt ok about going without my Thai partner. She still has an infection. I told him 'not Amoxycillian' and explained. The prescribed medicine is labeled AMOXY200+CLA28. What can I do now?

I would suggest bringing your kid to Singapore to treat. Personally I trust the doctors in Singapore than in Thailand, especially when anything associated with kids, rather be safe than sorry.

KK Children hospital Singapore, specialising in children.

Hope your kid will be ok asap.

What you have is combination of amoxicillin and clavulanate, best name under brand name augmentin. While the addition of the clavulanate does broaden the antibiotic spectrum, I am concerned by the sheer amount and duration of antibiotic therapy she has already had. How much azithro did she take for how long?

I am not clear what the indications are of infection that are requiring prolonged antibiotic treatment. Is there a discharge that can be obtained for culture and sensitivity? As that is the way to go. Does she have a fever? An elevated while blood count? (Both indicative of a bacterial infection). Or is it possible there is not even an infection but rather just residual irritation/inflammation?

I would suggest getting a second opinion from a pediatric ENT and insisting in a culture and sensitivity of any drainage along with a CBC (complete blood count) to help determine if a bacterial infection is present and if so, caused by what organism and sensitive to what antibiotics. Further "shot gun" approach with antibiotics on top of all that she has already had is not likely to help and may be harmful.

Where do you live?

I live in Pattaya. A big problem we have is that with decent care we have to pay out of pocket. My partner is a security guard so we've be using the government and Wat Yan schemes. The Azithromycin we were told was very strong but worked slow so she had only one bottle.

That is a problem, and if you have been using govt facilities I would bet no culture has been done.

I suggest you consider making a trip to Bkk and paying to consult Prof. Songklot at St. Louis Hosp, he is an excellent ENT with special training in peds. A consultation with him will cost around 600 baht.If there is anything to culture then will need to pay for a culture and sensitivity, not sure but maybe 300-500 baht for that. It is the only way to know what the causative organism is and what antibiotic it will respond to -- if indeed there are clinical indications of a continued bacterial infection at all.

I'm afraid you alternative is possibly unnecessary abx treatment and mounting antibiotic resistance.