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What Do My Gram Stain Test Result Indicate?

Posted on Fri, 13 May 2016

Question: Hi, my one year old son has been having a throat infection since Saturday, Feb 27. He had fever Sat through Mon that went away Mon eve - he has been fever free since. However, he still has a cough that gets worse in the night. We were prescribed nebulization with levolin, livocid, and ascoril. He is doing better each day - today, he had solids, coughed little and is active. However, he had a lot of difficulty sleeping last night. The doc did a gram stain test which says "Occasional gram positive cocci seen with pus cells and epithelial cells". My question is should we start antibiotics? One of the peds says yes and the other says wait n watch for a day. Please advise ASAP. Thx!

Answered by Dr. Deepak Patel (15 minutes later)

Brief Answer:
Wait for 1 more day

Detailed Answer:
Hi,
Welcome to hcm.
Can understand your concerns.

Since child had fever and cough which is worse at night and gram stain shows occasional gram positive cocci, it indicates that child had infection.
But as there is no fever now and child is active and improving, chances are that infection has settled or is settling.
Also, gram stain shows occasional gram positive cocci which also indicates that infection is settling.
I suggest you to wait for 1 more day and if symptoms din't improve or fever occurs then only we should start antibiotics.
I hope this will help you.
Take care.

Above answer was peer-reviewed by : Dr. Deepak

Follow up: Dr. Deepak Patel (18 minutes later)

But, what about the cough? It seems like it's coming from the chest and has some phlegm. Should we wait despite that? Thx!

Answered by Dr. Deepak Patel (16 minutes later)

Brief Answer:
Yes we should wait

Detailed Answer:
Hi,

You have already mentioned that there is no fever now, child has started taking solids and is active which clearly signifies that child is improving.
Cough should also have improved but since all other things have improved, it is advisable to wait for 1 more day.
And if after that cough persists then we should start antibiotic.
Take care.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Deepak Patel (11 hours later)

Thanks for your response!

You mentioned that the report suggests infection is settling. How do you discern that? Is it because it says "occasional" gram positive. If there was an active infection, what would the report say?

Also, he had trouble sleeping last night. No fever but woke up couple of times although we gave him advair and 2 puffs of levocin. However, once he wakes up, his cough does not bother him and he is active and happy through the day. Should we still give the antibiotic?

Finally, even if we decide to give him an antibiotic, which one shall we give? Our doc said "Clamp" that is more broad purpose - but we were not sure if we should adopt such a strong solution for a throat infection. Why not Azithral?

Thanks for your understanding!

Answered by Dr. Deepak Patel (15 minutes later)

Brief Answer:
Clamp will be a better option

Detailed Answer:
Hi,

I told that infection is settling because now there is no fever, cough decreased and child is active.
Gram stain report cannot tell us about recovery of child.
Clamp will be a better option than azithral.
Clamp is a broad spectrum antibiotic and covers Gram positive cocci as well.
Take care.

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Above answer was peer-reviewed by : Dr. Prasad