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SPECIAL CONSIDERATIONS

Dental

If PANDAS/PANS symptoms continue beyond 2 weeks, oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be beneficial. The medications appear to be particularly useful for exacerbations (or “mini-flares”) which occur in the weeks following immunotherapy. Assuming that the PANS and PANDAS condition is the result of an immune system disorder, reducing inflammation would have a beneficial effect for patients. Follow dosing level provided by the manufacturer’s label. The cyclo-oxygenase inhibitor, celecoxib, is another NSAID that has been reported to be helpful. Mechanisms of action are unknown. All the NSAIDS carry risks of GI bleeding and other side effects, so they should be used with caution, following manufacturers’ guidelines for dosage and duration of therapy.
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Probiotic

In order to maintain a proper balance in the microbiome while a PANS/PANDAS patient is undergoing antibiotic therapy or prophylaxis, the providers caring for PANS/PANDAS patients should consider multi-strain probiotics. Probiotics are available in colony forming units (“CFU’s) and the correct CFU dosage for children and adults must be considered as part of the therapy.
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