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Author Topic: Why wouldn't a doc put me on bactrim?  (Read 3918 times)

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Offline Esquare

  • Member
  • Posts: 237
Why wouldn't a doc put me on bactrim?
« on: October 12, 2006, 06:30:56 PM »
My tests show me with a cd4 of 112 and high VL. He had me on Dapsone but due to an allergic reaction he took me off. I asked about an alternative such as Bactrim but he said he wants my cd4 numbers up a bit before he puts me on it. Is there a reason for this approach that anyone is aware of? I don't want to pick up an OI.

Offline Teresa

  • Member
  • Posts: 1,753
Re: Why wouldn't a doc put me on bactrim?
« Reply #1 on: October 12, 2006, 07:43:45 PM »
When Hubby was first diagnosed his CD4s were 85 and his Dr had him on Bactrim. He developed a rash from it and the Dr switched him to Dapsone. He went and has his labs done yesterday and he asked how long he would be on Dapsone and she said he had to have a CD4 count over 200 for 3 months.

Did he give you anything else other than Bactrim since you cant take Dapsone?
Seems like to me you should be on something to keep you from getting an OI. Maybe someone more knowledgeable than me can give ya some advice.

Hugs
Teresa
Hubby HIV+ 5/5/06
CD4:320
  %: 26.7
 VL: <20
Atripla (started it 8/24/06)
 

Offline penguin

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  • Posts: 747
  • The Penguin Whisperer
Re: Why wouldn't a doc put me on bactrim?
« Reply #2 on: October 12, 2006, 07:52:28 PM »
Hi,
dapsone has a sulpha base, which is often what causes the allergy. Bactrim is also sulpha-based, and a lot of people experience allergic reaction to it..

so am gonna guess, your dr is thinking the chances of you having another, possibly more serious allergic reaction, are quite high with the bactrim. People with low cd4 counts can be more  likely to experience reactions too.

that said, there are a couple of other choices, like atovaquone, which you could be on to protect you from infection - important, because your cd4 is under 200.

hope that helps, a bit.

Kate

Offline Esquare

  • Member
  • Posts: 237
Re: Why wouldn't a doc put me on bactrim?
« Reply #3 on: October 12, 2006, 07:58:31 PM »
Hi,
dapsone has a sulpha base, which is often what causes the allergy. Bactrim is also sulpha-based, and a lot of people experience allergic reaction to it..

so am gonna guess, your dr is thinking the chances of you having another, possibly more serious allergic reaction, are quite high with the bactrim. People with low cd4 counts can be more  likely to experience reactions too.

that said, there are a couple of other choices, like atovaquone, which you could be on to protect you from infection - important, because your cd4 is under 200.

hope that helps, a bit.

Kate

Yes I am alergic to Sulfur as that is the 2nd sulfur medicine I've had the reaction to. I saw a thread here mentioning that there are some other medicines that would protect me from a few OIs but that they were very expensive. Is there some place here that talks about drugs like atovaquone or others?

Offline SoSadTooBad

  • Member
  • Posts: 248
Re: Why wouldn't a doc put me on bactrim?
« Reply #4 on: October 12, 2006, 09:14:29 PM »
I just did a 4 month course of Mepron (atovaquone) because my T-cells were down to 78, and I too had an allergic reaction to Bactrim - the doctor said not to bother with Dapsone, since it was sulfa-based as well, and people with low T-cell counts are especially likely to have allergic reactions to sulfa antibiotics.

Mepron is a liquid, which should be taken with a substantial snack or a meal.  I was on it once a day - 10ml per dose.  It looks like bright yellow paint, but tastes like citrus.  Had no real side effects - maybe a little nausea right after I took it, but a few chugs of cold water made that go away.

There is no generic form, and only GSK makes it, so it is expensive.  I believe it retails for about $600 per month - so about $20.00 per day.  My insurance charged me a $40.00 co-pay for it. 

One other aspect of it is that Mepron is not something that the average pharmacy has in stock.  My pharmacy had to order it almost every month that I needed it, so it is important to refill it a few days before you get to the end of the bottle.

I went about a week between stopping Bactrim and starting Mepron - I was totally panicked that I would get PCP in the interim days, but my doctor kept re-assuring me that, in most cases, it takes quite a while to develop.

Sorry for the lenghty post - hope it helps. 

Offline allanq

  • Member
  • Posts: 689
  • still life with pills
Re: Why wouldn't a doc put me on bactrim?
« Reply #5 on: October 12, 2006, 09:30:55 PM »
I started Bactrim in 1995 and had a bad allergic reaction. My face turned beet red, and I felt like I had a constant fever. However, after a process of desensitization, I was able to tolerate the Bactrim. The desensitization process consisted of starting with an extremely low dose and then building up gradually over a period of about two weeks to the standard dose. The first attempt didn't work for me, but I tried it again and it did work. I've been taking Bactrim ever since that time.

During the desensitization, you take the Septra in liquid form. The escalating doses have to be prepared by a pharmacist.

Allan

Top (Breakfast): Prezista, Norvir, Isentress, Zoloft (2), Glyburide (2), Aspirin
Bottom right (Dinner): Prezista, Norvir, Isentress
Bottom left (Bedtime): Sustiva, Trazodone (2), Lipitor, Septra (no longer taking this)
Center: Alprazolam (Xanax)
Not shown: various vitamins & supplements

Offline Christine

  • Member
  • Posts: 1,069
Re: Why wouldn't a doc put me on bactrim?
« Reply #6 on: October 13, 2006, 12:16:00 PM »
Bactrim and Dapsone are both sulfa based drugs. I agree with the other posts, that the doctor figures if you are allergic to Dapsone, then you will problably be allergic to Bactrim.

Two other alternatives are Mepron (atovaquone) or aerosolized pentamidine.

If you can, print out some info from these forums and take it in to discuss with your doctor. Sometimes it helps to have your questions and information printed out in front of you when you speak with the doctor.

Christine
Poz since '93. Currently on Procrit, Azithromax, Pentamidine, Valcyte, Levothyroxine, Zoloft, Epzicom, Prezista, Viread, Norvir, and GS-9137 study drug. As needed: Trazodone, Atavan, Diflucan, Zofran, Hydrocodone, Octreotide

5/30/07 t-cells 9; vl 275,000

Offline kykeith

  • Member
  • Posts: 13
Re: Why wouldn't a doc put me on bactrim?
« Reply #7 on: October 16, 2006, 11:32:20 AM »
hey there...I was started on Bactrim when I had a 47 CD4 and had a major rash breakout.  Due to what others on here have said due to a sulfur reaction.  I was switched to Dapsone at which time the rash continued. My doc was concerned because the rash was affecting my immune system. Note: One thing I had to do was wait several days in between switching the two so that the Dapsone didn't pick up on the same reaction.  However, for me it didn't work. 

My doc was very concerned about OI so he then put me on pentamine which I did every four weeks at the hospital. It was a breathing treatment -- not too bad just inconvenient.  With my insurance it was about $100 each time.  I offically hit 290 CD4s a couple of weeks ago and was able to stop the pentamine. YEA!!!  Good luck on this.  Keith

Offline budndallastx

  • Member
  • Posts: 463
Re: Why wouldn't a doc put me on bactrim?
« Reply #8 on: December 03, 2006, 10:26:26 AM »
I had a severe reaction to Bactrim after being on it for a week.  I ended up being hospitalized with very low blood pressure (80/40) and it took about a day to get me back to "normal".  The emergency room staff initially thought the problem was the Epzicom but the symptoms didn't match.  I was discharged last Thursday (11/30) and am on a steroid regiment through next Tuesday.

My doctor has prescribed Dapsone for me and I am reluctant to start on that since it's also a sulfa based drug.  I heard some of you mention desensitization  therapy and was wondering if this really works?  I would hate to go through the events of Tuesday (beet red, full out itch, dizzy, etc.) again.

Meds since: 11/20/2006
Sustiva / Truvada
12/08/2008 VL:<48 CD4 622 (38%)   
9/8/2008 VL:<48 CD4 573 (30%)
5/2008 VL:<48 CD4 464 (30%)
1/2008  VL: <50  CD4 425(28%)
9/2007   VL: <50  CD4 465 (27%)
6/2007   VL: <50   CD4 443 (26%)
3/2007  VL: <50   CD4 385 (25%)
12/2006 - VL: <50   CD4: 384 (25%)
11/2006 - VL:  22K  CD4: 208 (18%)

Offline Teresa

  • Member
  • Posts: 1,753
Re: Why wouldn't a doc put me on bactrim?
« Reply #9 on: December 03, 2006, 10:39:22 AM »
Hubby has been on Dapsone since June. He had a rash from Bactrim but never developed one with the Dapsone. Hope it works out for you.

Hugs
Teresa
Hubby HIV+ 5/5/06
CD4:320
  %: 26.7
 VL: <20
Atripla (started it 8/24/06)
 

Offline dgls44

  • Member
  • Posts: 69
!
« Reply #10 on: December 05, 2006, 12:28:12 AM »
~
« Last Edit: December 24, 2006, 01:15:44 AM by dgls44 »

Offline budndallastx

  • Member
  • Posts: 463
Re: Why wouldn't a doc put me on bactrim?
« Reply #11 on: December 05, 2006, 10:49:14 AM »
I have an appointment on Tuesday (12/13) tio discuss this very option.  Once I have the information, I'll post it on here for everyone's common knowledge. 
Meds since: 11/20/2006
Sustiva / Truvada
12/08/2008 VL:<48 CD4 622 (38%)   
9/8/2008 VL:<48 CD4 573 (30%)
5/2008 VL:<48 CD4 464 (30%)
1/2008  VL: <50  CD4 425(28%)
9/2007   VL: <50  CD4 465 (27%)
6/2007   VL: <50   CD4 443 (26%)
3/2007  VL: <50   CD4 385 (25%)
12/2006 - VL: <50   CD4: 384 (25%)
11/2006 - VL:  22K  CD4: 208 (18%)

Offline jjmcm

  • Member
  • Posts: 78
Re: Why wouldn't a doc put me on bactrim?
« Reply #12 on: December 05, 2006, 09:19:30 PM »
Hey, Bud.  I had a very bad reaction to Bactrim many years ago.  The doctor put me on Dapsone and I had an even worse reaction that not only put a rash over my entire body, but also put me in the hospital because I couldn't breathe.

I highly recommend that you do Mepron for a month or so even if you plan to eventually try the Dapsone.  That way if your CD4's hang above 200 for a month or so, you don't even have to start the Dapsone.  Personally, if I was over 200 CD4's, I would not do anything.

As far as desensitization, it works for some.  However, my doctor says that at least 50% of those who restart it eventually have another reaction.  The last time I dipped under 200 CD4's for a while I did both pentamidine and Mepron.

--JJ

Offline aztecan

  • Member
  • Posts: 5,398
  • 29 years positive, 57 years a pain in the butt
Re: Why wouldn't a doc put me on bactrim?
« Reply #13 on: December 06, 2006, 09:30:14 AM »
Hey Esquare,

Here is a link to some information that may be helpful to you.

http://www.aidsmeds.com/OIs/PCP4.htm


HUGS,

Mark
"May your life preach more loudly than your lips."
~ William Ellery Channing (Unitarian Minister)

Offline alterman

  • Member
  • Posts: 48
Re: Why wouldn't a doc put me on bactrim?
« Reply #14 on: December 08, 2006, 01:10:44 AM »
Bactrim can be bad for your kidneys,That is why my doc took me off of them.

Offline chemistry001

  • Member
  • Posts: 142
    • http://www.mygaydar.com/chemistry001
Re: Why wouldn't a doc put me on bactrim?
« Reply #15 on: December 08, 2006, 12:49:03 PM »
Bactrim or Septrin caused me to have kidney problems, Chronic Tubular Necrosis as they called it, i was then put on Clindamycin for a while while my CD4 is still so crap (started on 9, now at 50). I'm back on the bactrim but at a very low dose. So any problems with the kidneys and they may look at alternatives

Paul xXx
Diagnosed 01/08/06
CD4-9, VL->500,000, CD4% 1
Started on Sustiva/combivir 22/08/06 changed to kivexa 18/09/06
02/10/06
CD4-50, VL-1496, CD4% 5
04/12/06
CD4-112, VL-125, CD4% 7.5
22/02/07
CD4-121, VL-<50, CD4% 9
29/05/07
CD4-125, VL-71,(re-done 149), CD4% 11
25/09/07
CD4 -231, VL-74, CD4% 15
Cant remember the next few dates
17/01/08  Kaletra and Truvada
CD4 - 281, VL-115
06/03/08
CD4 - 287, VL-178

 


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