posted
I have been doing some research lately for Bart, trying to come to some conclusion as to what the best Tx is. A popular Tx by LLMD's is Levaquin + PPI, but I can't find any studies that recommend this regime. I did find one that recommended Levaquin 750 mg + Mino as a first line Tx, but then you have the potential problem of tendon damage to consider. There have been numerous Tx failures reported with levaquin also.
I have come accross numerous studies that recommend the use of Rifampin. However; the dosing is not consistent. Some say 300 mg bid + 100 mg Doxy bid, some say 600 mg once + doxy, some say 600 mg bid + 500 mg cipro bid, some say 900 mg once a day. One study said 600 mg 4 x's a day + Doxy
I have noticed that Rifampin does help people to feel much better after a period of feeling really bad. A lot of people quit on it because the herx is too much for them. Others stick it out, and are able to make it through ok.
But I have also noticed that when some people try to come off of it that they relapse very quickly, even after being on it for months. One case in particular is Auntybiotics mother. She was on 600 mg bid, double the dose of Rifampin (by mistake initially) for a long time with much improvement, but when she came off it she relapsed. Maybe she wasn't taking the right combo with it. I wish that I knew why for sure, but the following study may explain why this happens.
It is a harsh drug, and I wouldn't want to subject myself to it if it will not end up doing the job that I need it to do.
Question for those of you that take it: Do you take it 1 hr before or 2 hrs after meals like it is suppose to be taken?
STUDY OBJECTIVE: The standard daily dose of rifampin in directly observed treatment of Mycobacterium tuberculosis (TB) is 600 mg, taken orally. The purpose of this study was to assess the efficacy of standard dose rifampin therapy in patients who were slow to respond to routine directly observed therapy (DOT). METHODS: Patients with non-drug-resistant pulmonary TB who were receiving 600 mg of oral rifampin by DOT were eligible for inclusion. Patients were deemed slow to respond if their sputum smears and cultures remained positive for M tuberculosis and if the patient's condition did not improve clinically or radiographically after 3 months of treatment. Serum rifampin levels were ascertained to determine the adequacy of the standard rifampin dosing. Patients with subtherapeutic blood levels had their rifampin dose increased to 900 mg, and rifampin levels were repeated. Rifampin dosage was increased again if blood levels were still subtherapeutic. No antitubercular medications were added to the treatment regimen. The total weekly dose of the other standard treatment drugs was not increased. RESULTS: Of 124 new patients with active pulmonary TB, 6 patients were identified as slow to respond to the standard antitubercular DOT. All six patients had subtherapeutic serum rifampin levels. All six patients responded clinically, radiographically, and mycobacteriologically after an increase in rifampin dosage to reach target drug blood level. CONCLUSIONS: Standard dosing with rifampin resulted in a poor clinical response and subtherapeutic serum levels in six patients. Increasing the dosage of rifampin improved the outcome without additional side effects. In TB patients who are slow to respond to standard treatment, an inadequate dose of rifampin should be suspected. Current antituberculer drug administration does not include adjusted dosage for rifampin.
Daily treatment with rifampin is often better tolerated than intermittent therapy, since rare hypersensitivity reactions may occur. Resumption of treatment after termination of a course of long-term therapy with the drug involves risks and therefore should, if possible, be avoided. If unavoidable, possible adverse reactions may be minimized if the drug-free interval or rest period is less than or closely resembles the interval of the previous drug treatment period. When resuming treatment with rifampin, the drug should be re-introduced gradually, beginning with a daily dose of 75 mg and increasing the dose by 75 to 150 mg on the first day. The desired therapeutic dose should be reached within 3 to 4 days. During the transitional period, renal function should be closely monitored. Corticosteroids may be useful in attenuating possible immunological reactions. If as may happen in exceptional cases, the patient develops thrombocytopenia, purpura, hemolytic anemia, or renal failure, treatment should be stopped at once and not re-instituted at a later date.
-------------------- You're only a failure when you stop trying. Posts: 945 | From U.S | Registered: Oct 2004
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lymeinhell
Frequent Contributor (1K+ posts)
Member # 4622
posted
During my treatment for Lyme and Bart, the ONLY meds used were Rifampin (300 mg, twice a day) and Flagyl (375mg once a day). I always took Rifampin on an empty stomach, an hour before I ate.
I initially herxed so bad my skin was on fire after 10 days. I had to stop for 3 days and restart at tiny doses (about 1/2 capsule a day, and built up from there).
The Bart was gone after about 4 months, and I continued to progress so well on this combo, my LLMD felt no need to switch. Rather, we added in Cat's Claw, and cut Rifampin to 300mg once a day.
Over the next 4 months, we very very gradually reduced Rifampin (minus 1 pill a week, every 2 weeks), and switched to pulsing Flagyl on weekends. This wean-off was so gradual, I guess it gave my body enough time to adjust to fighting on its own.
My one year anniversary of being abx free is soon approaching.
-------------------- Julie _ _ ___ _ _ lymeinhell
Blessed are those who expect nothing, for they shall not be disappointed. Posts: 2258 | From a better place than I was 11 yrs ago | Registered: Sep 2003
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caat
Frequent Contributor (1K+ posts)
Member # 2321
posted
Now you have me wondering if I should up my rifampin...
Any idea of any symptoms which might give a clue as to blood levels? color of urine maybe??
FWIW I looked at the different doses too and am taking 600mg once a day. I'm not having that much of a problem with it except extreme fatigue, but have been on doxy for 3 years and my bart load may be low. & I'm on 600mg rifampin, 400mg doxy and 500mg zith all at once. So... I guess I should be tired.
The only thing I could find on the discrepencies of taking it once a day or twice was a study on horses which have very different systems than we do. So- I don't know if this is relevant, but I'm guessing it might be. I can't remember the exact elimination times but it went something like this; total elimination is 7 hours when given twice a day and 13 hours when given once a day. This was stated to be because rifampin activated something in the liver, making it work faster if it was activated 2ce a day. Sorry- did not save the url.
Those are total elimination times in horses. The half life in humans is less than half of that.
Rifampin may or may not be as nasty as you think it's going to be. I thought it would be as bad as flagyl but it hasn't been. It's been pretty bearable compared to everything else. You probley know to ramp up...
Using it combined with Zith is more effective than doxy for most species of bart according to some ID manuals/reports (see website below- go to co-infections/bart). I kept taking the doxy as 400mg crosses the bbb and has some effect on bart whereas rifampin does not cross the bbb unless the bbb is comprimised. Zith doesn't cross either.
Roxithromycine may be as effective as zith if you can get the *real* stuff (I got fake stuff before from an online drug co) and it does cross the bbb. Should be cheaper too. Hard to get stuff you know is real though- it's not sold or rx'd in the US.
Posts: 1436 | From Humboldt county ca usa | Registered: Mar 2002
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caat
Frequent Contributor (1K+ posts)
Member # 2321
posted
oh. They do recommend tuberculosis patients take rifampin with food if it gives stomack upset. I did see one reference to rifampin absorbtion being decreased 30 something percent (39%?) *if taken with a full high fat meal*. Like a cheeseburger and fries for instance. Taken with low fat snack would be much better and more absorbtion.
I don't know if they considered that variable in the above study or not...
Posts: 1436 | From Humboldt county ca usa | Registered: Mar 2002
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posted
Thanks Julie for your post. Good to know that you didn't relapse after stopping Tx.
Caat: It's a very short half life. I don't think that you could tell if your dose was inadequate based on symptoms. It would have to be done by a blood test most likely. Whether Doxy or Zith is the best choice to use with it doesn't matter for you because you have it all covered. That's quite a load you're carrying there! Of course you're tired.
Biological Half-life: In normal subjects the biological half-life of rifampin is approximately 3 hours with variations from 1 to 5 hours. Biliary obstruction causes a longer half-life but kidney blockage does not appear to cause a change.
Excretion: Rifampin is eliminated from the blood equally in the urine and feces as unchanged drug and metabolites. Approximately half of the original dose eliminated by the bile is unchanged drug. The proportion of unchanged drug to metabolite is less in the urine than in the bile. In the presence of complete renal shutdown, the drug is excreted entirely in the bile.
The principal metabolite in man is the biologically active desacetyl-rifampin. Its excretion appears to be a dynamically changing picture at all times.
Desacetylation of rifampin in the body does not substantially modify its antimycobacterial activity.
-------------------- You're only a failure when you stop trying. Posts: 945 | From U.S | Registered: Oct 2004
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