I have Bart and have been treating with Zithromax 500mg and Rifampin 600mg for about 6 months. Some of my symptoms are somewhat improved, but for the most part I'm not a lot better. And my mood instability is worse. I was put on this combo because I reported a good response to Zithromax alone before I tested positive - so my Dr. figured it would be a good combo to start with. But now we are considering switching it up. Has anyone been treated with Zith/Rifampin and not had results but then switched and gotten better? What did you switch to? I think the next suggestion was to switch the Zithromax to Doxy and keep the Rifampin. Or maybe to Levaquin.
When Dr. B says in his recommendations that "BLO" doesn't respond to "normal" Bart meds and requires does he mean Zith/Rifampin/Doxy? But then it responds to Levaquin? Is that maybe whats going on here...
BTW - the mood instability is the worst.
Posts: 116 | From Ann Arbor, MI | Registered: Nov 2007
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Hoosiers51
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Levaquin is supposedly good. Has some serious side effects though, so read up on that.
The thing that worked best for me with Zithromax was Bactrim DS (also known as Septra DS). REALLY cleared up my brain, and helped clear up my psychological symptoms.
Another thing that helped my psych symptoms that I'd suggest for you is Zithromax with Plaquenil. The Plaquenil helps the Zithromax penetrate better. There are studies that document this, I can pull them up if you'd like.
I took Zith on it's own, but found it to be much more effective with Plaquenil added.
So Zith/Plaquenil and Zith/Bactrim DS were the two things that helped me a lot. It can vary person to person though.
You might even be able to take Zith/Plaquenil/Bactrim DS...but I would not add both at the same time. You will need to run that interaction on drugs.com to be sure they can go together.
Overall, Zith/Plaq helped my psych symptoms more, and Zith/Bactrim DS helped my cognition more. So I benefited from both in different ways.
I used to be very emotionally volitaile, and now I am very normal psych-wise. I went off my mood stabalizer after Zith/Plaquenil. I was only on that combo for 3 months max I'd say.
I did Rifampin also...I didn't get any benefit from it. I was extremely tired the whole time I was on it. Keep trying different things. It's not one size fits all.
If you are dealing with true Bartonella and not "BLO," things should start to change pretty quickly (as early as the first day for herxing, benefits seen as soon as 3-6 weeks in). So if you do 2-3 months of treatment, and see nothing, it probably isn't gonna help you for Bart. That's my experience, and it makes sense considering Bartonella has a short life cycle.
"BLO" is a different story, can't comment on that.
Posts: 4590 | From Midwest | Registered: Jun 2008
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Hoosiers51
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oh PS--I get the sense that what Dr. B calls "BLO" responds to Levaquin and/or Rifampin.
I bet you have regular Bartonella, because it would make sense Bartonella responds to Zith... because I think that's been documented in non-LLMD literature (stuff that pre-dates when LLMD's figured out ticks carried Bart, back when it was thought to be only cat scratches etc)
So I think Zithromax and Doxy are normal Bart meds, and Rifampin and Levaquin are BLO meds. I could be WAY off base though...I'm just going by memory, from reading the Dr. B Guidelines, and by what I've read about normal Bartonella on Wikipedia.
Posts: 4590 | From Midwest | Registered: Jun 2008
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CD57
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I think I read that b. quintana, another strain of bartonella, must be treated with gentamicin and rocephin + doxy. I don't know if we will find anyone here who has done that.
Posts: 3528 | From US | Registered: Apr 2007
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blinkie
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I did septra and rifampin and went into remission. it was a short lived three weeks after stopping the meds though. Bummer.
I've doen rifampin with others since then to no avail.
I am in the process of completing IM gentamicin with doxy. It has worked for most of my bart symptoms. Question is...will it stick once I stop? I'll let ya know!
Posts: 1104 | From N.California | Registered: Jan 2008
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how do you know your bart is gone. do you have complete clearing of psych/cog stuff? or must some of this be attributed to lyme? i wouldn't know when to quit. i still have obvioous symptoms like eye pressure, heel pains, and streaking along with god awful derealization i see this world with 70% of my concious senses.
-p
-------------------- Bit in March 2005. Posts: 58 | From Jersey | Registered: May 2008
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Thanks for the responses. I just don't know. I tested positive for Bart Vinsonii and Bart Heselae. I never tested for anymore than the 41kd band for Lyme and I didn't have any response to Doxy alone. I did herx on Zithromax and Rifampin. It made me a lot more tired and achey and irritable for a few weeks, but then I levelled back out to my normal "sick" and didn't see much in the way of improvement since. So I guess I haven't gotten much worse, well except the mood swings. I was trying to avoid going on a mood stabilizer, but I might have to. But then how do you know if the infection is getting better if the mood sx are being supressed by psych meds?
Posts: 116 | From Ann Arbor, MI | Registered: Nov 2007
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Oh and FWIW - according to this article bart pretty quickly gets resistant to Zithromax. No so with Doxy and Gent. Less so with Cipro and Enerofloxacin (vet med). They don't mention Septra or Levofloxacin in that article, but it doesn't meant they don't work - only that they weren't tested...
Hoosiers51
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I wouldn't worry about the mood stabalizer and knowing when Bart's gone.
The Zith/Plaquenil combo helped me so much, that after the herxing had subsided, I just "knew" that I was ready to stop my mood stabalizer, because I felt so much more leveled out emotionally. Like the little bit of edge the mood stabalizer wasn't taking away was gone.
And keep in mind that the mood stabalizer was working, but I could just tell that I didn't need it anymore, and that I'd be fine without it.
I could see that Zith alone wouldn't work. Plaquenil helps Zithromax work better. I'll come back with the link for that for you.
Zith/Plaq helped my psych symptoms, and then later, Bactrim DS/Zith helped my cognition and spaced out feeling. I think the Bactrim DS was the major factor in that combo.
As far as when you know when it's gone, I just knew. It was intense herxing, followed by relief of symptoms I thought would never go away. And the whole thing did NOT take very long. I wasn't on either of those combos for more than 3 months. You may see benefits as soon as 3 weeks.
With regular Bart, not BLO, when something's working, it doesn't take long. Unlike Lyme, which can take time. I can't comment on BLO.
Sorry if some of this is a repeat on what I might have said above....I just can't keep track of what I say in each post, so there may be repeating of info. Posts: 4590 | From Midwest | Registered: Jun 2008
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Hoosiers51
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Here's one article that touches on the Plaquenil (hydroxycholorquine) and Zithromax (a macrolide) combo.
I thought that Plaquenil helps Zith in general though, not just for Lyme. I could be wrong. But maybe this same phenomenon regarding the acidic endosome applies to Bartonella too.
Or, maybe my success on the combo was due to Lyme, not Bart being treated. Who knows.
But with the Bactrim DS, I am very inclined to believe at least that was a Bart herx, because Bactrim DS is supposedly not very affective against Lyme, and my herx symptoms seemed Bart-like.
posted
Cipro is supposed to have activity against Bart and can be taken with doxy, biaxin, or flagyl. I believe Dr. J has written an article touting the benefits of Cipro.
Doxy works by inhibiting protein synthesis within bacteria. Cipro works by inhibiting DNA gyrase necessary for DNA synthesis. The idea is that, instead of using 2 intracellular abxs, you combine a cell wall inhibitor with an intracellular abx which might enhance the effectiveness of the treatment.
Although my testing came back negative for Bart, I had most of the specific Bart symptoms. Levaquin did not really help me.
I then had a course of doxy (200 mg twice daily) and cipro (250 mg daily for 1 week, then 250 mg twice daily for 3 weeks). I followed that with a course of biaxin and flagyl, which I am currently taking. My symptoms seem to have been reduced, and I am no longer having afternoon fatigue.
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