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Posted: Fri Oct 29th, 2004 05:25 |
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I need to take a different antibiotic for awhile. What should I do?
ER document: http://AutoimmunityResearch.org/ER.pdf
Verify the diagnosis
"If your doctor has ordered a short course of a non-MP antibiotic because you have a suspected infection, first verify that it is an acute bacterial (not viral) infection and that another antibiotic is necessary.
Immunopathologic symptoms may appear very similar to symptoms of infection, especially in the area of ears, throat and sinuses. In most cases, there is time to do a culture and sensitivity to verify the diagnosis and select the correct antibiotic. See My doctor thinks I have an upper respiratory infection. What should I do?
"Medical diagnosis is an imprecise art. Just about every diagnosis is likely to be incorrect, and is a judgment call. It is not my personal experience which makes me question a diagnosis, any diagnosis, but the 'inside knowledge' of how imprecise the art of medical diagnosis really is. I always regard every diagnosis with suspicion, and every good clinician will keep a diagnosis under ongoing review." Trevor Marshall, Ph.D
Urgent or emergency situations
In the case of an obvious acute bacterial infection or in an emergency situation, you will need to follow the doctors orders to start the needed antibiotic right away. Inform the doctor of the last time you took Benicar and that it may potentiate the antibiotic and cause an immune system reaction. You will, of course, discontinue the Benicar and any MP antibiotics.
If you have been taking Zithromax, inform the doctor that it may be synergistic with the new antibiotic for a few weeks as it lingers in your tissues. Therefore, be alert for a potential immune system reaction and treat symptoms as they arise.
Prophylactic antibiotics
Dentists and surgeons sometimes order a brief course of an antibiotic before a procedure. Verify that this is essential for you. Ask your doctor if the current MP antibiotics you are taking would suffice to prevent infection.
"Any of the beta-lactams (like amoxicillin) give unpredictable, and sometimes severe, reactions once your immune system is functioning properly (on the MP). Bactrim will exacerbate your immunopathology terribly - don't use that. Biaxin might be OK...some people get immunopathology with it, some don't. But it is a risk." ~Dr. Marshall
We cannot tell you what will happen if a non-MP antibiotic is administered to you during surgery or how a fluoroquinolone might affect you either. We have little data on non-MP meds used during the MP but reports from several members who have successfully used Ciprofloxacin and Levofloxacin, which are flouroquinolones.
Surgeons often have set routines regarding the antibiotics they use and they may have little understanding of how Th1 disease affects you systemically. Work with your doctor to come to an agreement. The choice of which non-MP antibiotic to use is a bit of a gamble. But the decision should be yours because you will have to live with it.
Continuing Benicar and MP antibiotics while taking a fluoroquinolone
The flouroquinolones are not terribly effective against mycobacteria. See for example the rickettsia susceptibilities study at http://tinyurl.com/576az The full text shows the flouroquinolones are 1/20 as effective against the rickettsia as doxycycline. We don't use flouroquinolones on the MP because they don't seem to touch the L form bacteria we have found that they produce little or no immunopathology (IP).
If your doctor wants you to take a different antibiotic, tell him/her it's important you continue the MP if possible. Suggest that s/he order a fluoroquinolone antibiotic because it will kill bacteria with cell walls but will not be effective against intracellular bacteria. That way you can continue Benicar and MP antibiotics.
If needed, you can adjust your dose/schedule of Benicar and/or minocycline (and any other MP antibiotics you are taking) to reduce immune system reactions.
Fluoroquinolones:
Cipro (ciprofloxacin)
Levaquin/Quixin (levofloxacin)
Avelox (moxifloxacin) (dental info)
Ocuflox/Floxin/Floxacin (ofloxacin)
Noroxin (norfloxacin)
See also Fluoroquinolone Antibiotics
Please note that there is a risk of tendon damage with fluoroquinolones but the risk is very small if you are not elderly and not taking steroids.
Claforan
Claforan (Cefotaximine Sodium) is a broad spectrum antibiotic which offers broad antimicrobial coverage and is indicated for the treatment of patients with serious infections caused by susceptible strains of the designated microorganisms. It is administered intramuscularly or intravenously. It works in a different way than the MP antibiotics by inhibiting cell wall synthesis so it should not cause immunopathology and may be used while continuing the MP (Benicar and MP antibiotic/s). This is a good antibiotic to use if you are hospitalized with a serious infection so you can continue the important Benicar blockade.
Dental work
If your doctor wants you to take a different antibiotic for prophylaxis before dental work or cleaning, ask him/her if you can postpone the work until you have progressed further on the protocol. This will give your teeth a chance to heal and eliminate stopping the MP in the early stages when you are still learning to manage the MP meds or stabilizing your symptoms. An when your bacterial load is lower, an antibiotic challenge will be less of a threat.
See Antibiotic prophylaxis for dental work
This study lists a possible better alternative- moxifloxacin (Avelox), a fluoroquinolone, to the amoxicillin or clindamycin usually prescibed by dentists. The benefit of this drug (Avelox) is that you could continue on the Benicar.
May 2007:
In the past, the American Heart Association has published antibiotic prophylaxis guidelines for dental procedures for people at high risk of cardiac infection. The American Heart Association recently revised their guidelines that had been in effect since 1997, as reported by the American Dental Association. The AHA now thinks antibiotics prior to dental care may not work as intended (to prevent infective endocarditis) and should be reserved for the highest-risk patients.
The American Heart Association's new guidelines about antibiotic prophylaxis, which are available on their website - are something you may want to discuss with your dentist.
Minocycline
If you have been on the MP and your doctor does not think a fluoroquinolone is appropriate, you can suggest that Minocycline can effectively treat or prevent many acute bacterial infections (even MRSA). Ask Doc if it would be appropriate for your situation. If you are quite ill and your immunopathology is likely to be unstable this may not be an option to consider.
The usual dose of 100mg Mino twice daily could be attempted. High-dose, frequent Minocycline has an anti-inflammatory effect and usually does not produce a severe immune system reaction. When the acute infection is resolved or prophylaxis is no longer needed, gradually wean the Minocycline back to the MP dose and schedule that provides tolerable immunopathology. First wean down the dosage but maintain the same frequency of dosing, and then, when you are at the level of minocycline you know you can tolerate, start to increase the interval between doses until you get back to q48h.
If you cannot a fluoroquinolone or Claforan
If you cannot take a fluoroquinolone or Claforan and must take another non-MP antibiotic, discontinue Benicar and minocycline (and any other MP antibiotics you are taking) 48hrs before beginning the non-MP antibiotic to avoid a possible severe immune system reaction.
Avoid other MP antibiotics
You will be more likely to get an immune system reaction with antibiotics that are on the Marshall Protocol (except high-dose minocycline as above). The important thing is to put in writing and share with your medical team the antibiotics that you cannot receive because they are likely to cause an immune system reaction- Zithromax (azithromycin), clindamycin and sulfanomides.
You may simply say you are allergic to these antibiotics and doctors will respect the potential for a reaction. Although technically you aren't allergic to them, reporting that you have an allergy to them and cannot receive them is probably the easiest thing for your doctor to understand and accept.
If you are not sure if the new antibiotic is an MP antibiotic, please ask on the website.
Do NOT take Zithromax (azithromycin, Z-pak)
If your doctor wants you to take a high dose of Zithromax for a short period of time, ask him/her to consider a different antibiotic or consult with Dr. Marshall. Zithromax is our most effective antibiotic against intracellular bacteria. Also, CWD bacteria are weakened and more susceptible after you have been taking Benicar.
Taking high dose Zithromax does not have an anti-inflammatory effect as do some of the other MP antibiotics. It could be very dangerous for someone who has been on the Marshall Protocol to take a high dose of Zithromax because it might provoke a severe immune system reaction.
If you are currently taking Zithromax, you should wait 2-3 weeks to allow it to wane from your tissues before taking the new antibiotic.
How to manage an intolerable immune system reaction
If you take a non-MP antibiotic and symptoms increase, they should be considered immunopathology and use of MP meds tried first to dampen the immune system reaction. Use your knowledge of what adjustment of MP meds works for you decrease symptoms to tolerable. See What to do when immunopathology (immune system reaction) is too strong.
How to resume the MP
You can resume Benicar-only 48hrs after the last dose of the non-MP antibiotic unless you have been taking Zithromax, in which case you must wait two weeks before resuming Benicar.
Wait a day or two to see if you have any intolerable adjustment symptoms to Benicar and then resume minocycline. If you took the non-MP antibiotics for just a day or two, you can resume minocycline at your previous dose. If the non-MP antibiotic course was longer, restart minocycline at a lower dose to avoid a strong immue system reaction.
Related FAQ:
I need to have surgery/dental work. What should I know about anesthesia and the MP?
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Foundation Staff
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Posted: Thu Sep 14th, 2006 05:39 |
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(filelink)
Members experiences
Marion Villa wrote:
"I have taken avelox for a flu which was indeed a flu last winter.
I didnt stop benicar, I stopped other antibiotics, but I didnt have to. I stopped them because of the normal IPR was giving me a bad time with the bad feeling of the flu.
I took only the avelox, and had a mild unpleasnt reaction about headache and dizziness, but helped a lot with the green mucus and the fever. And it worked quickly."
The cephalosporins are a class of B-lactam antibiotics. We cannot tell you what will happen if one of these antibiotics is administered to you during surgery.
I can tell you my own experience. Six months before I started the MP, I had pelvic surgery and was given IV Ancef (a cephalosporin) during surgery. Less than 12 hours post-op, I had a fever of 101 (38.4C) which was eventually attributed to a "cytokine release". For 24 hours I was unable to move my left leg which is my primary site of inflammation (tibial neuropathy). Both these symptoms gradually resolved without intervention and I did not receive any antibiotics post-op. I was heavily medicated with IV pain meds so I cannot tell you what other symptoms I might have felt during that time but I do remember the surgeon's obvious concern about the fever (infection) and paralysis (possible nerve injury done during surgery).
Of course, we don't know how a fluoroquinolone might affect you either. IMO, it's going to be a gamble whatever you decide to do. But the decision should be yours because you will have to live with it.
Last edited on Sat Sep 12th, 2009 05:08 by
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