Dr. Kumar’s Take:
This small pilot study suggests that azithromycin, a common antibiotic, may reduce OCD symptoms in children with PANDAS or PANS, especially if tics are also present. While results were mixed across different rating scales, but many children improved noticeably within just 4 weeks.
Key Takeaways:
✔ Azithromycin led to a stronger drop in OCD symptoms on one key clinical scale.
✔ More kids in the azithromycin group met the “treatment responder” criteria.
✔ Children with tics showed even more improvement.
✔ No major side effects, but possible heart rhythm issues mean caution is needed.
Actionable Tip:
If your child has sudden-onset OCD and tics, ask your doctor whether a short course of azithromycin might be worth exploring.
What This Study Looked At:
Researchers studied 31 kids aged 4 to 14 who had sudden, severe OCD, often tied to infection-triggered inflammation—what we now call PANDAS or PANS. They were randomly given either azithromycin or a placebo for 4 weeks. The goal was to see if symptoms improved more in the azithromycin group.
All participants also took probiotics during the study to protect gut health.
Study Design:
- Participants: 31 children with PANDAS or PANS (62.5% male, average age 8.3)
- Treatment: Azithromycin (10 mg/kg daily, max 500 mg) or placebo for 4 weeks
- Measures Used:
- CGI-S OCD: Clinical rating of OCD severity
- CY-BOCS: A detailed checklist of OCD behaviors
- CGI-I OCD: A rating of improvement at the end
What They Found:
- OCD severity dropped more on the CGI-S scale in the azithromycin group compared to placebo (p = 0.003)
- More children were rated as responders on the CGI-I in the azithromycin group (41.2% vs. 7.1%, p = 0.045)
- No significant difference on the CY-BOCS scale, possibly due to its narrow focus
- Tic severity predicted better outcomes—kids with more tics improved more
- No major side effects, but the azithromycin group had more loose stools and a possible trend toward increased QTc (a heart rhythm measure)
Why Azithromycin Might Help OCD in PANDAS or PANS
Azithromycin isn’t just an antibiotic—it also lowers inflammation in the brain and body. In PANDAS or PANS, the immune system may overreact after an infection and start attacking parts of the brain linked to behavior, like the basal ganglia. Azithromycin could work by killing the bacteria responsible for the infection, calming this inflammation, and stopping the immune response before more damage is done.
Related Studies and Research
PANS Treatment: Large Survey Study – Examines treatment trends and outcomes in a large community-based sample.
IVIG for PANDAS: Pediatric OCD Trial – Reviews IVIG’s effectiveness in a randomized trial.
PANDAS Strep Antibiotic Recovery Study – Details how antibiotics affected symptom recurrence post-strep infection.
Podcast: Could Your Child’s Behavior Changes Be Cured with an Antibiotic? – A deep dive into the link between strep infections and dramatic neuropsychiatric symptoms.
Frequently Asked Questions
What is PANS?
PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and PANDAS (Pediatric Acute-onset Neuropsychiatric Syndrome Associated with Streptococcal Infections) are conditions where children suddenly develop OCD, anxiety, tics, or food restrictions, often after an infection.
Why use an antibiotic for OCD?
In PANDAS or PANS, the OCD is believed to be triggered by the immune system’s response to infection. Azithromycin may reduce this immune overreaction.
Is azithromycin safe for kids?
Generally yes, but it can sometimes affect heart rhythm. It should only be used with a doctor’s guidance and possibly an EKG.
What if my child doesn’t have tics?
This study showed better results in kids with tics, but that doesn’t mean others won’t benefit. Future research may clarify who responds best.
Conclusion
This study offers hope that azithromycin might help children with PANS, especially those who have both OCD and tics. While not a silver bullet, it appears well-tolerated and worth considering.