Meds and infections?

[handmademitlove]

I am currently on sulfasalazine and leflunamide. When I get an infection, the GP will give high dose antibiotics as a precaution. I currently have a dental abscess and the dentist says a) a mild course of antibiotics is all that is needed to protect against it becoming systemic and it won't get rid of the infection anyway and b) waiting list to have tooth removed to remove abscess is a couple of months.

Gp is not happy for me to have infection untreated for this long but can't tell dentist what to do ...

Any suggestions? Had one week of antibiotics which reduced the size of the abscess but has since grown again... Not sure whether to go back to dentist?

Do you have a Clinician who you can contact regarding your immunosuppressive status (specialist Nurse/ rheumatologist etc?) If so I would suggest getting in touch and discussing with them.
It certainly goes against everything I know about immunosupression (Nurse and also have a serious autoimmune problem).
This is surely a case for getting expedited treatment? Could you afford to have a private extraction ?

My main concern would be sepsis- did the dentist mention his view on this?

Do you have a Clinician who you can contact regarding your immunosuppressive status (specialist Nurse/ rheumatologist etc?) If so I would suggest getting in touch and discussing with them.

100% this if you have access to one. I've been on different biologics and now on Rituximab infusions, so my immune system is next to zero.

If I'm refused medication for an infection by my GP (hasn't happened so far), my Rheumatology Specialist Nurse will prescribe them to me.

I'm a Rheum nurse. We generally advise patients on a course of antibiotics to withhold their medication whilst on them until the course is finished and their infection is better. This helps the antibiotics to work better. However without knowing your medical history it's difficult to advise...I assume your Rheumatology department has an advice line? It would be better to give them a ring and they will advise you, referring to a consultant if necessary, especially if the antibiotics are long term. How often do you have monitoring blood tests? We monitor our patients' blood tests ourselves and quickly contact the patient if the bloods show any abnormalities or we're worried about possible sepsis but I know in some areas that's done by the GP

Currently with a private rheum so no nurse to contact. He said I need to make an appointment to discuss it as he won't discuss clinical matters outside the consulting room. Which is fair enough I guess. I have an appointment next week so will ask him then.

Dentist said they only change treatment plan if they have been told to do so by consultant - but how am I supposed to know that consultant needed to tell dentist just in case!

Private appointment is still a few month wait as needs specialist removal.

Bloods done this week and okay so not too worried yet! Gp has prescribed an extra course just in case but told me to go to a&e if I get a temperature out of hours.

I can't work out if I should worry or not. To be fair, I didn't see my regular dentist as it was an emergency appointment. Perhaps I should make appointment with regular dentist for review?

And no one suggested stopping meds... Gp said not necessary with the antibiotics I was given? Amoxicillin?

I guess I am not confident that the dentist understood the situation? She seemed quite blase about the whole thing and said they wouldn't normally bother even with antibiotics...

It's great you've got an appointment with the consultant next week, he it she will sort it out then. Don't stop any meds if you haven't been told to, wait to see what the consultant says. A lot of GPs don't tell patients to stop, we tend to but be guided by your own consultant. Just tell them what you've told us. You'll get a copy of the clinic letter with a plan which you could show to the dentist. It's very reassuring your bloods are ok. Try not to worry, the consultant will know what to do. If you do feel the infection is getting worse and you are getting a fever etc then seek medical advice, otherwise wait for the consultant appointment x

@florizel13 thank you. While I am grateful that private appointments are covered by health insurance (my own GP told me I was just getting old and wouldn't refer until I told her I had insurance!), the NHS clinics have specialist nurses to contact in these situations which would be helpful! Consultant is waiting for meds to be stable before referring to back to NHS for ongoing support.

You're welcome. Yes once you're stable you should be referred to NHS where there'll be a team of consultants, nurse specialists, specialist physio and OT, pharmacist...at least that's how it is with us! Good luck with everything! X

Just to update - my rheumatologist was not very happy and suggested I stop my meds until two weeks after the tooth has been removed. He couldn't understand why they didn't treat the abscess straight away and said it was still a risk due to the meds staying in your system for a long time.
I also went back to my regular dentist who asked a lot of questions - I don't think even he fully understood the effect of the meds on the immune system. Asked why a local infection was a sepsis risk (!). But then agreed to another course of antibiotics and if the visible swelling hasn't reduced, he will drain the abscess pending removal of the tooth. Interestingly the first dentist suggested root canal would be the first choice but would take longer so I declined. The dentist today said that with root canal work, they rely on the bodies own immune system to then clear the infection - which even he said was unlikely to happen in my case so wasn't an option!

Thank you all for your advice!