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» LymeNet Flash » Questions and Discussion » Medical Questions » Starting / Stopping Rifampin - Urban Legand or Truth?

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Author Topic: Starting / Stopping Rifampin - Urban Legand or Truth?
bcb1200
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I've read in a few threads how one should NEVER start / stop / pulse Rifampin.

The reasons seem to vary, but the concensus believe it can cause resistance by doing this.

I'm wondering if this is real or urband legend / myth?

I have not seen a single medical reference stating that starting / stopping Rifampin may cause resistance. I recall maybe one "official" source which said it isn't a good idea due to side effects and the way the drug impacts the body (i.e. the "Flulike" feeling that is common when starting it.) And I remember Dr. B stating that one should never TAPER a dose of a drug or else resistance is likely.

I'd like to know what others think and hear what the source is. Can you provide any?

This reminds me of the urband legend that you can't take Artemisinin by itself / alone / without antibiotics otherwise Babesia will become resistant. Well, Stephen Buhner says that is a big Urban Legend.

http://planetthrive.com/2009/04/babesia-developing-resistance-to-meds-and-herbs/

"It is extremely rare that bacteria develop resistance to herbs. They do, and easily, develop resistance to antibiotics. I discuss this in my Herbal Antibiotics book and in Lost Language of Plants (see book links below) in even more detail. The resistance rumor is just that, an urban legend. "

I ask because I just started Rifabutin and found out today that I may need to stop it after a month for about 2-3 weeks and then restart again.

--------------------
Bite date ?
2/10 symptoms began
5/10 dx'd, after 3 months numerous test and doctors

IgM Igenex +/CDC +
+ 23/25, 30, 31, 34, 41, 83/93

Currently on:

Currently at around 80% +/- most days.

Posts: 3127 | From Massachusetts | Registered: May 2010  |  IP: Logged | Report this post to a Moderator
Jamers
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I have to do the same thing to do H. Pylori treatment. I have been off Rifampin for one week and have another week to go. Then I have to get back on it. I had to quit due to taking acid reducers.

I was concerned about getting the flu like syndrome but my LLMD assured me that she has patients that have to stop and restart and have no issues whatsoever. I hope she is right!

--------------------
Diagnosed Pos. Lyme Nov. 17, 2010, Igx.
Pos. Babesia Duncani March 2011, Igx.
Clinical diagnosis for Bartonella

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Jamers
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I have to do the same thing to do H. Pylori treatment. I have been off Rifampin for one week and have another week to go. Then I have to get back on it. I had to quit due to taking acid reducers.

I was concerned about getting the flu like syndrome but my LLMD assured me that she has patients that have to stop and restart and have no issues whatsoever. I hope she is right!

--------------------
Diagnosed Pos. Lyme Nov. 17, 2010, Igx.
Pos. Babesia Duncani March 2011, Igx.
Clinical diagnosis for Bartonella

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anuta
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However, Dr. J. is puling all the abx in his protocol, Rifabutin is included. He believes that pulsing the meds allows immune system to build-up.
He only uses this way to treat and has successively
put many patients into remission.

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nonna05
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PM , Nonna But 3 ID doctors told me this....You know what we usually think of this source , but who knows.

I know after I was on it for over 7 weeks and they took me off . I had to wait 6 months before and started ,lower, slower.

I had a reaction at the first go round, but no diagnoses.. So maybe herx.?/ That would be weird after a few weeks. The first three to four weeks I thought I had my life back. But again they had no idea what they were treating ,other than an infection that included Psuedenomas SP?

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nefferdun
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Every site I brought up said not to quit Rifampin too early because the bacteria will develop resistance.

Rifampin cannot be pulsed because:

Immunologic

The 'flu-like syndrome' generally occurs with intermittent dosing of rifampin, in patients with poor adherence to daily rifampin therapy, and when daily rifampin is resumed after a drug free period.

p://www.drugs.com/sfx/rifampin-side-effects.html

One of the LLMDs I saw said it was pointless for me to continue artemesinin because taking it without atovoquane caused babesia to develop resistance to it. As I was very sick and had been taking it for a long time with Bactrim DS, I have to agree.
It does nothing for me. Artemether is helpful but it is the strongest derivative.

--------------------
old joke: idiopathic means the patient is pathological and the the doctor is an idiot

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little_olive
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Did you google it? There is tons of information out there about Rifampin and bacteria resistance! It causes this when the rpoB gene mutates.

Here's one study specific to bartonella:
http://www.ncbi.nlm.nih.gov/pubmed/17449882

Here's one explaining rpoB and bartonella:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC87755/

Probably best explanation:
http://onlinelibrary.wiley.com/doi/10.1111/j.1469-0691.2008.02179.x/pdf
quote:
This study also confirms

the high level of in-vitro susceptibility of B. quintana

to doxycycline and amoxicillin even after a

long time of in-vitro selection. Thus, it seems

reasonable to prefer doxycycline in association

with another antibiotic for the treatment of

patients with B. quintana infections (bacteraemia

in homeless people or endocarditis). On the other

hand, as it is very easy to obtain the rifampin-resistant

strain of B. quintana in vitro,
we believe

that this compound should not be used alone in

the treatment of human bartonellosis.

Of course we know rifampin cannot be used alone because of the reistance factor. My LLMD says if you make it past ten days, the risk is slightly decreased (granted the person is on combination therapy).

What causes resistance, is when you pause an antibiotic that has a high rate of causing resistance, such as rifampin. With bartonella replicating every 5-7 days, the result is a bacteria that can very quickly mutate and become immune. Some antibiotics such as Doxy hardly ever do this, while Cipro and Levaquin are even "worse" than Rifampin. Azithromycin is pretty terrible as well--I've personally has this one stop working after three pauses, and there is lots of information about its ineffectiveness in bartonella (specifically in solo therapy, but even while in combination therapy, it still applies).

If you take it for a while and have to stop it once, maybe twice, you should be fine. But some people try to pulse it, or start it for a couple of days and then stop it because of herxing, then try to start again, and do this repeatedly trying to "handle" the drug (inadvertant pulsing) and all they're doing is givg the bacteria enough exposure to create rifampin-resistant genes. I almost always post when I see that and let people know you cannot do that, it's too risky.


Hope this helps

--------------------
Myalgic encephalomyelitis, 2002 | Viral onset, following Hep B vaccine
Lyme since '06 | Bartonella since '08 (cured) | Mycoplasma pneumoniae since '08
IGeneX: IgM 31IND 34IND 41+ | IgG 39IND 58+ 41+++
IgG deficiencies and MTHFR 677TT mutations

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beths
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"However, Dr. J. is pulsing all the abx in his protocol".


I often wondered about this as well. I think maybe for lyme you can pulse-not so sure about babs and bart as they replicate faster.

I would love to pulse-but my LLMD doesn't believe in it.

Posts: 1276 | From maryland | Registered: Jan 2009  |  IP: Logged | Report this post to a Moderator
   

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