Long-term Antibiotics for PANDAS

Children who’s had a recurrence of PANDAS are often given antibiotics for an extended period as a form of prevention, or prophylaxis, for recurring strep infections. Strep is so common in the school population that it is now recommended that prophylaxis continue until patients are about 21, Dr Swedo says. “You want to get them through college, boot camp — places where they’re going to have high exposure to things like mono and strep.” Research shows that antibiotic prophylaxis can reduce significantly the number of episodes of PANDAS symptoms a child experiences.

Unfortunately, even the strep prophylaxis won’t prevent all later episodes of PANDAS symptoms because the immune system, once primed, continues to react dangerously to other kinds of infections as well, misidentifying the brain as foreign, and generating symptoms.

“But by preventing the strep,” Dr. Swedo notes, “you prevent over three quarters of those episodes, and you get them down to the point where then symptoms can be controlled with traditional anti-depressant medications and CBT.”