Since getting my + test for Bart from IGENEX (1:80), my llmd has decided to try Ceftin (250mg 2x/day) with Rifampin (300mg 2x/day). These came through my pharmacist, but with no further instructions from llmd, and he's out of the area for awhile, so I'm hoping you all with be able to offer some advice.
So, just to be safe..I've researched here and found out that you shouldn't ramp up Rifampin, or take it by itself. (Initiallly I was just ordered Rifampin, but called llmd before he left and ?? if that was right, then he ordered Ceftin to go w/ it).
Now, I've read that you can't ramp up slow with Rifampin, though I wasn't warned about this...why is this a problem?
Also, should I start Ceftin first BEFORE Rifampin and if so, how long? Also, was told by pharmacy to take Ceftin WITH food..and Rifampin With NO Food.
I asked him, with that in mind..you can't take the two together, right? He said, you shouldn't, but I should ask my llmd as of why...as of he hasn't had any orders of these two antiboticis together before. Can anyone shed some light on HOW to take these two?
What are some side effects that these can have?
Many, many thanks in advance..not much on search regarding using these two only for Bart and am very confused.
JavaBeing
Posts: 208 | From Portland, OR USA | Registered: Oct 2004
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I haven't heard of anyone taking Ceftin for Bart. I have read a lot of studies on rifampin, and I haven't seen it mentioned as any part of an effective drug combo for it.
Ceftin is a cephalosporin. Studies say that these and penicillins are not good invivo for bart. Instructions for ceftin say that it can be taken with or without food.
It is Ok to ramp up on rifampin if you choose to. You should be guided by your Dr on this. Ramping up means to start taking the drug at a reduced dose, and increasing it up to the full dose over a period of time. So if your Dr said to take at 300 mg 2 x a day, you might start it at 150 mg for a few days to see how you do. There are differing opinions on doing this, so you really should do what your Dr wants you to do.
The thing that you can't do is pulse it; meaning that you can't start and stop the drug, or take it every other day. It has to be taken every day.
Are you seeing Dr H. in Northern Calif? Is this Dr an LLMD that Rx'd Ceftin for Bart?
-------------------- You're only a failure when you stop trying. Posts: 945 | From U.S | Registered: Oct 2004
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posted
I am taking ceftin rigt now - Make sure you take it with food - also myke sure you are doing some kind of probiotic support. Ceftin can be ahrd on the gut and intestines. When I first started there was a lot of stomach pain and intestinal. It has leveled off. Ceftin doe get throught the Blood barrier. I felt a lot of little neuro stof going on while I addjusted to it. I have heard of a number of people who have taken Rifampin for bart with good results. The ceftin is working quite well right now That's all I know.
Posts: 582 | From milwaukee wi | Registered: May 2005
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valymemom
Frequent Contributor (1K+ posts)
Member # 7076
posted
Took levaquin by itself the first month for bart and levaquin/ceftin (2000 mg) for bart/lyme this second month.
It was so exciting over a week ago to finally be able to read the newspaper after months of not getting beyond headlines.
Something is working!
I wish we did not have to try to figure so much out for ourselves......but we have one another. Thank goodness!
Good luck!
Posts: 1240 | From Centreville,VA | Registered: Mar 2005
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posted
Thanks everyone for your thoughts and insights..
Micul--thanks for the info regarding Ceftin. Do you know where I can find the info you mentioned on cephalosporins not working invivo for Bart. I'm wondering if this is just to target the lyme, but then back to the question does it nulify the effects of Rifampin?
Johnlyme1--I'm very happy to hear of your positive results with the ceftin. Thanks for the heads up regarding how hard it is on the stomach...my digestion issues have been a problem for many months, I hope this isn't going to add to them. But crossing the BBB is very important in getting to the lyme neuro stuff, which I have as well.
Valymemom--Well, your combo is encouraging in that you're taking levquin/ceftin for Bart. Do you know if Levaquin and Rafampin are in the same abx family? Very happy to hear of your progress!
If anything "positive" lyme does, is make you appreciate all the things we have/do that we take for granted. I miss reading as well, one of my favorite passtimes...looking forward to having it back real soon!
I noticed you stated you are on 2000 mg of Ceftin. Is that your starting dose, or have you moved up through the months? I'm on 300mg/2 day.
Totally agree with you as well as how hard this is to figure out, find answers, ask the right questions. This board and our friends on it, are the true blessing as we all go through this maze together.
Thanks everyone for all your help...just wish I wasn't feeling like a guinea pig with this Ceftin & Rafampin combo!
and progress to all, JavaBeing
Posts: 208 | From Portland, OR USA | Registered: Oct 2004
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posted
Ceftin will not nullify the effects of Rifampin, but it will not work together with it against Bart, which might cause early resistance to it. It is usually taken for Lyme.
Here is a snippet from one study:
TREATMENT Section 6 of 10 Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography
Medical Care: Recognition of BA is critical because antibiotics cure most patients. Treatment recommendations are based on retrospective studies or clinical observations. No antibiotics have been studied prospectively. Available information on efficacy is derived from clinical experience and a few case reports.
Clinical experience strongly favors the use of erythromycin or a tetracycline derivative. Erythromycin remains the drug of choice because it has an excellent clinical response in almost all patients. Tetracyclines are the first alternative for patients who cannot tolerate erythromycin secondary to adverse gastrointestinal effects. A combination of doxycycline (100 mg PO/IV q12h) plus rifampin (300 mg PO bid) may be used in patients with severe disease who are immunocompromised.
Other antibiotics display in vitro activity, but in vitro susceptibility data do not accurately predict the in vivo situation. Penicillins and cephalosporins have no activity against Bartonella, despite in vitro susceptibilities. Clarithromycin, azithromycin, chloramphenicol, ciprofloxacin, trimethoprim-sulfamethoxazole, rifampin, isoniazid, and gentamicin combined with either doxycycline or ciprofloxacin produce a good clinical response. These antibiotics have been used successfully in limited numbers of patients. Treatment failures with ciprofloxacin, trimethoprim-sulfamethoxazole, isoniazid, and rifampin have been reported.
A reaction resembling the Jarisch-Herxheimer reaction has been described upon the initiation of appropriate antibiotic therapy. The reaction is characterized by fever, myalgias, and constitutional symptoms.
The optimal duration of therapy is not known. Recommendations are based on clinical experience rather than scientific data. Usually, recommendations indicate to treat skin lesions for 8-12 weeks and osseous and liver lesions for at least 3 months, although these have not been studied in prospective randomized trials. Patients with HIV infection may require life-long therapy if relapses occur.
The cutaneous lesions resolve substantially after approximately 4-7 days of therapy, and usually they resolve completely after 1 month.
Corticosteroid therapy, cytotoxic therapy, or radiation therapy is not effective.
-------------------- You're only a failure when you stop trying. Posts: 945 | From U.S | Registered: Oct 2004
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valymemom
Frequent Contributor (1K+ posts)
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posted
JavaBeing
This llmd is one who doesn't ramp.......just dives right in.
I did have a couple days of reflux and thrush developed. I emptied lots of acidolphilus capsules in my mouth to suck on the powder and used peroxide swishing...... and that helped. I am now on nystatin to avoid more potential yeast problems.
My 19 year old is diving in with three combos of abx next week without ramping. My other son - under another llmd - though, did ramp his mepron last year.
I am forced to keep a calendar and rate my symptoms and this has been a great help for me because I am able to see the cycling. Try that.
In January my husband will undergo testing (he has such air hunger) and then four of us will be on abx......
Keep everyone informed as to how this treatment goes.
Posts: 1240 | From Centreville,VA | Registered: Mar 2005
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Micul--Many thanks for the info....definately gives more insight into the best combinations to use with Rifampin, along with some alternatives (again as many have said, none that mentions Ceftin...argg ) I've never tried any of the Erythromycins or tetra groups...hmmm.
Only thing I've been on is Biaxin (worked great!) and the IV Rocephin. I am to start on IV Clarofan here with the next few weeks..I wonder if THAT is to be used with the Rifampin as it's co-antibiotic? I know Rocephin and Clarofan are similiar in their effectiveness...I'm not sure what abx family it is under....though I haven't read anything regarding in studies sites that I've been sent to.
Thanks also for the info on pulsing vs ramping...wish I could get ahold of my llmd to find out if that would be a possiblity as well as why the Ceftin.
Valymemom--I'm so sorry your whole family is having to deal with this. You have my admiration (especially as a mom myself) for the strength, energy and peserverance it takes to work through this, both for yourself AND other family members as well. Many hugs to you...(is your husband being tested for Bart? I've read air hunger is one of the symptoms...)
I don't know if I can ramp up or not...good to know NOT to pulse. At least with ramping, you can start off gradually and let your body adjust.
Hey Cave--Very good read on the Rifampin and the interactions with the other meds. Many thanks! Got to say, this portion gave me the willy's though...
"overdoses in adults have been reported with doses ranging from 9 to 12 gm rifampin. Fatal acute overdoses in adults have been reported with doses ranging from 14 to 60 gm. Alcohol or a history of alcohol abuse was involved in some of the fatal and nonfatal reports."
That just gave me the warm and fuzzies Sounds like issues with the liver being overwhelmed with clearing out toxins might be a concern...well, no alcohol for us lymies, so at least we don't have that factor to add to the mix. Geez....
Well, I'm off to see if the IV Clarofan might be the possiblility that's suppose to be good with the Rifampin, though not much on that combo either...Wish I could just read to the end of this lyme book and see how it's suppose to work out
Thanks again everyone for the info...still not sure of my direction, but at least I've got a map now.
JavaBeing
Posts: 208 | From Portland, OR USA | Registered: Oct 2004
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caat
Frequent Contributor (1K+ posts)
Member # 2321
posted
>>>Micul--thanks for the info regarding Ceftin. Do you know where I can find the info you mentioned on cephalosporins not working invivo for Bart.
Here's a couple more (pdf files) with more info on cephalasporins being ineffective for bart and also info on more likely combos.
caat
Frequent Contributor (1K+ posts)
Member # 2321
posted
I read in another post that dr B recommends ceftin in combos for bart tx. HOWEVER...
Uhmmmm... you know, you guys, dr B is a very good dr and I'm sure he's a great person, but he is not GOD. Like everyone else, sometimes he makes mistakes. I think he may have read only half of the info on this before making a recommendation.
Cephalasporins and penicillians are effective against bart *in VITRO* but the evidence that is available strongly suggests they are NOT effective in VIVO. In other words, it looks good in the petri dish but doesn't translate to an effective treatment in real life.
Cephalasporins and penicillians are extremely poor drugs for bartonella.
Whatever the source of information on anything... it's always a good idea to double check.
Posts: 1436 | From Humboldt county ca usa | Registered: Mar 2002
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caat
Frequent Contributor (1K+ posts)
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>>>Now, I've read that you can't ramp up slow with Rifampin, though I wasn't warned about this...why is this a problem?
Oh, because things build up resistances to rifampin easily. It has a very short half life. You can search other recent bart/rifampin posts for more info on that. Look in the "bartonella buddies" post.
Posts: 1436 | From Humboldt county ca usa | Registered: Mar 2002
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JavaBeing
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