Re: ICH-Bactrim

[Guest guest]

Here's the citation on Bactrim (trimethoprim/sulfamethoxazole):

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=

pubmed & dopt=Abstract & list_uids=1415302

The reports of several classes of abx provoking ICH could mean

that the ICH is secondary to die-off, or it may be that people who

are already near the point of decompensation can be pushed

passed that threshold by a variety of drugs, and abx just happen

to have been noticed as culprits because they are commonly

prescribed.

Matt

>

> Wow, I've also heard that Cipro can induce ICH in some

people, but didn't know about Bactrim.

[Guest guest]

I had a wicked reaction to Bactrim after the 2nd dose- and had to

stop- I waited a few days to recover, them weaned myself up by

taking 1/16th dose, the next day 1/8th dose, the next day 1/4 daose,

etc..

At the time I didn't know whether I was having a drug reaction or a

herx (you know how much controversy there is in that area).

My symptoms were aching joints (REALLY aching joints).. fever and

head ache. I actually had to miss a day at work and lay around at

home to recover.

I still don't know which reaction it was.

But I had read where over 50% of immune compromised people (AIDS

article) had to wean onto Bactrim... they take it low dose (500 mg

once or twice a week)... and after they wean onto it they' can

tolerate it.

Barb

> >

> > Wow, I've also heard that Cipro can induce ICH in some

> people, but didn't know about Bactrim.

>

[Guest guest]

I've had three bad reactions to abx, each one yielding important,

serendipitous insights. But the biggest insight has been elusive--is

my disease fundamentally a bacterial infection, or something else?

You experienced fever from Bactrim. This would indicate endotoxemia.

And in light of your tremendous response to abx, no one can doubt that

you had a bacterial/protozoal cause to your disease. But cipro didn't

make me feverish. My reaction seemed to parallel classic PTC/ICH.

Then there's Penny--Cipro made her feel better. If memory serves, the

fluoroquinolones are the one class of abx that are viewed primarily as

proinflammatory, not antiinflammatory. That should make an

interpretation of Penny's reaction to Cipro fairly unambigous--

bacteria cause her problems.

Antibiotics have done a lot of things to me, but they haven't made me

feel better, and they haven't made me feverish.

Still trying to answer the Big Question....

>

> At the time I didn't know whether I was having a drug reaction or a

> herx (you know how much controversy there is in that area).

> My symptoms were aching joints (REALLY aching joints).. fever and

> head ache. >

> Barb

>

[Guest guest]

Matt, Which 3 abx did you react badly to again? And have you reacted positively to any abx? Also, what about the vancomycin? Didn't you say you got it in pill form? I thought that was only available in i.v. If it's in pill form, I need to know, because that's one that might actually work for me. penny phagelod <mpalmer@...> wrote: I've had three bad reactions to abx, each one yielding

important, serendipitous insights. But the biggest insight has been elusive--is my disease fundamentally a bacterial infection, or something else? You experienced fever from Bactrim. This would indicate endotoxemia. And in light of your tremendous response to abx, no one can doubt that you had a bacterial/protozoal cause to your disease. But cipro didn't make me feverish. My reaction seemed to parallel classic PTC/ICH.Then there's Penny--Cipro made her feel better. If memory serves, the fluoroquinolones are the one class of abx that are viewed primarily as proinflammatory, not antiinflammatory. That should make an interpretation of Penny's reaction to Cipro fairly unambigous--bacteria cause her problems.Antibiotics have done a lot of things to me, but they haven't made me feel better, and they haven't made me feverish.Still trying to answer the Big Question....> > At the time I didn't know whether I was having a drug reaction or a > herx (you know how much controversy there is in that area). > My symptoms were aching joints (REALLY aching joints).. fever and > head ache. > > Barb>

[Guest guest]

Penny

I reacted badly to cipro monotherapy. The reaction, along with your

previous statements and my drusen (papilledema?) taught me about

PTC/ICH.

I reacted badly to a cocktail--about 6 weeks into mino/azithro and 7

to 10 days into tinidazole I developed a severe rash. No one knew

for sure what to call it, but my PCP preferred serum sickness from

the mino. But the Urgent Care doc I first went to suspected the

tinidizale since 7 to 10 days would be plausible as a delayed

hypersensitivity. Bottom line: I don't know which of the three

antibiotics gave me the rash. The upside was that the high-dose

prednisone I was prescribed for the rash (taper started at 80 mg per

day) made me feel great, and this is useful info in terms of

deducing the nature of what ails me.

I don't know what antibiotics set me up for C diff, or when.

My " IBS " became monstrously grotesque after the abx cocktail, so

that cocktail may have made me vulnerable to a new C diff infection,

or it may simply have exacerbated a two-decades long C diff

infection.

The vancomycin was a spectacularly positive experience, but insofar

as it reversed the C diff that was caused by the use of other

antibiotics, I just consider it a net negative experience that

nonetheless taught me a lot.

Vancomycin is not absorbed systemically following oral

administration. If you're going after multi-drug resistant Staph,

or whatever vancomycin is usually used for, then it does have to be

administered IV.

Since C diff is entirely lumenal (contained within the GI lumen)

oral administration is fine, and even preferred. The vancomycin

stays at high concentrations in the GI tract when taken orally. The

reason you thought that it is only available IV is because the only

use for oral vancomycin is, to my knowledge, C diff. In virtually

every case, the patient will be prescribed Flagyl instead. So

vancomycin pills rarely see the light of day. I had to use them

because my prior allergic reaction to tinidazole (a close relative

of flagyl) made the use of flagyl potentially dangerous. Vancomycin

pills are so scarce that we had to call around to many pharmacies to

find them and it took to pharmacies just to fill one 10-day course.

Vancomycin is very expensive, and I don't think that oral vancomycin

would do want you want, since it's not absorbed systemically.

Matt

>

> >

> > At the time I didn't know whether I was having a drug reaction

or a

> > herx (you know how much controversy there is in that area).

> > My symptoms were aching joints (REALLY aching joints).. fever

and

> > head ache. >

> > Barb

> >

>

[Guest guest]

Ah thanks. Wish they could figure out how to make an oral vanco. Not looking forward to more i.v. experience or expense. pennyphagelod <mpalmer@...> wrote: PennyI reacted badly to cipro monotherapy. The reaction, along with your previous statements and my drusen (papilledema?) taught me about PTC/ICH.I reacted badly to a cocktail--about 6 weeks into mino/azithro and 7 to 10 days into tinidazole I developed a severe rash. No one knew for sure

what to call it, but my PCP preferred serum sickness from the mino. But the Urgent Care doc I first went to suspected the tinidizale since 7 to 10 days would be plausible as a delayed hypersensitivity. Bottom line: I don't know which of the three antibiotics gave me the rash. The upside was that the high-dose prednisone I was prescribed for the rash (taper started at 80 mg per day) made me feel great, and this is useful info in terms of deducing the nature of what ails me.I don't know what antibiotics set me up for C diff, or when. My "IBS" became monstrously grotesque after the abx cocktail, so that cocktail may have made me vulnerable to a new C diff infection, or it may simply have exacerbated a two-decades long C diff infection.The vancomycin was a spectacularly positive experience, but insofar as it reversed the C diff that was caused by the use of other antibiotics, I just consider it a net negative

experience that nonetheless taught me a lot.Vancomycin is not absorbed systemically following oral administration. If you're going after multi-drug resistant Staph, or whatever vancomycin is usually used for, then it does have to be administered IV.Since C diff is entirely lumenal (contained within the GI lumen) oral administration is fine, and even preferred. The vancomycin stays at high concentrations in the GI tract when taken orally. The reason you thought that it is only available IV is because the only use for oral vancomycin is, to my knowledge, C diff. In virtually every case, the patient will be prescribed Flagyl instead. So vancomycin pills rarely see the light of day. I had to use them because my prior allergic reaction to tinidazole (a close relative of flagyl) made the use of flagyl potentially dangerous. Vancomycin pills are so scarce that we had to call around to many pharmacies to find

them and it took to pharmacies just to fill one 10-day course. Vancomycin is very expensive, and I don't think that oral vancomycin would do want you want, since it's not absorbed systemically.Matt> > > > > At the time I didn't know whether I was having a drug reaction or a > > herx (you know how much controversy there is in that area). > > My symptoms were aching joints (REALLY aching joints).. fever and > > head ache. > > > Barb> >>

[Guest guest]

On Thu, Nov 02, 2006 at 11:22:50PM -0000, phagelod wrote:

>Penny

>

>I reacted badly to cipro monotherapy. The reaction, along with your

>previous statements and my drusen (papilledema?) taught me about

>PTC/ICH.

>

>I reacted badly to a cocktail--about 6 weeks into mino/azithro and 7

>to 10 days into tinidazole I developed a severe rash. No one knew

>for sure what to call it, but my PCP preferred serum sickness from

>the mino. But the Urgent Care doc I first went to suspected the

>tinidizale since 7 to 10 days would be plausible as a delayed

>hypersensitivity. Bottom line: I don't know which of the three

>antibiotics gave me the rash. The upside was that the high-dose

>prednisone I was prescribed for the rash (taper started at 80 mg per

>day) made me feel great, and this is useful info in terms of

>deducing the nature of what ails me.

>

>I don't know what antibiotics set me up for C diff, or when.

One tidbit that appears in Ewald's book " Evolution of

Infectious Disease " is that C. difficile is present in the guts

of about 1 out of every 50 people, without causing problems.

Ewald theorizes, because of this, that the strains that cause

people problems may be strains bred in hospitals (where diseases

have no incentive to evolve toward benignness, because attendants

can spread them even if they incapacitate the patient). So it

may have been as much a matter of which bug you picked up in the

hospital, as of which antibiotics set you up for it.

Speaking of hospital-bred infections, there was a good article in

Slate magazine recently, about MRSA:

http://www.slate.com/id/2152118/?nav=ais

" If you are an American admitted to a hospital in

Amsterdam, Toronto, or Copenhagen these days, you'll be

considered a biohazard. "

[Guest guest]

Aghhhh! A biohazard???? Geez, I mean I've felt like that sometimes and there's no way I would donate any of my body parts or blood to anyone, but they actually think it? Wow. pennyNorman Yarvin <norman.yarvin@...> wrote: On Thu, Nov 02, 2006 at 11:22:50PM -0000, phagelod wrote:>Penny>>I reacted badly to cipro monotherapy. The reaction, along with your >previous statements and my drusen (papilledema?) taught me about >PTC/ICH.>>I

reacted badly to a cocktail--about 6 weeks into mino/azithro and 7 >to 10 days into tinidazole I developed a severe rash. No one knew >for sure what to call it, but my PCP preferred serum sickness from >the mino. But the Urgent Care doc I first went to suspected the >tinidizale since 7 to 10 days would be plausible as a delayed >hypersensitivity. Bottom line: I don't know which of the three >antibiotics gave me the rash. The upside was that the high-dose >prednisone I was prescribed for the rash (taper started at 80 mg per >day) made me feel great, and this is useful info in terms of >deducing the nature of what ails me.>>I don't know what antibiotics set me up for C diff, or when. One tidbit that appears in Ewald's book "Evolution ofInfectious Disease" is that C. difficile is present in the gutsof about 1 out of every 50 people, without causing problems.Ewald theorizes,

because of this, that the strains that causepeople problems may be strains bred in hospitals (where diseaseshave no incentive to evolve toward benignness, because attendantscan spread them even if they incapacitate the patient). So itmay have been as much a matter of which bug you picked up in thehospital, as of which antibiotics set you up for it.Speaking of hospital-bred infections, there was a good article inSlate magazine recently, about MRSA:http://www.slate.com/id/2152118/?nav=ais"If you are an American admitted to a hospital inAmsterdam, Toronto, or Copenhagen these days, you'll beconsidered a biohazard."