prophelaxis

[poz1970]

Howdy,

I used to take bactrim as a preventative against a chest infection, but started getting an allergic reaction to it, so got taken off of it.

Recently the doc had me on "amoxycillin and Clavulanic acid", but I kept choking on the tablets....

My question is, does anyone know of another antibiotic of some sort that will work as well as bactrim does?

(I have almost constant lung/sinus infections, and loved when I was on bactrim for it... it cleared it up almost immediately)

J

[vokz]

A better solution for general respiratory infections (rather than as a PCP prophylaxis) would probably be to tell your doctor about the problem and ask for the amoxiclav (amoxicillin with clavulanic acid) to be described as lower dose tablets (ie. take more, but smaller, tablets) or to prescribe a low dose of amoxycillin alongside a lower dose (smaller tablet) of amoxiclav.

If your allergic reaction to co-trimoxazole (Bactrim) wasn’t too severe, it could be worth trying a few low doses of co-trimoxazole again to see if you have become sufficiently desensitised to it to tolerate it (you need to do that under medical supervision though).

Aerosolised pentamidine, dapsone plus trimethoprim and atovaquone are the standard alternatives to co-trimoxazole as a PCP prophylaxis; but that doesn’t mean that they will have the same unintended but desirable side effect (a degree of protection from other ENT infections) that you got from co-trimoxazole.

[poz1970]

Thanks for that, something to print out and show the doc next appointment :-D

J

[leatherman]

If your allergic reaction to co-trimoxazole (Bactrim) wasnt too severe, it could be worth trying a few low doses of co-trimoxazole again to see if you have become sufficiently desensitised to it to tolerate it (you need to do that under medical supervision though).

my tcells haven't been over 300 in the 10 yrs since my last bout of pneumonia so I've stayed on Bactrim all these years. I have a slight allergy to it also. My doc has me taking HALF the recommended daily dosage. Except for during the Summer (when I totally ignore the "avoid sunlight" warning because we have a pool) when I have a slight itch ALLL the time, I don't have any other problems. (Any day I get too much sun, I skip the sun and the Bactrim the next day so I don't break out in Hives) Perhaps you can tolerate it at a lower dosage too.

[vokz]

Good point.

I was assuming one 960g tablet, three times a week, as a standard prophylaxic dose. Even at that dose I would expect some all year round light sensitivity (even in the middle of winter I used to wear factor 15).

[leatherman]

I was assuming one 960g tablet, three times a week, as a standard prophylaxic dose. Even at that dose I would expect some all year round light sensitivity (even in the middle of winter I used to wear factor 15).

The recommended dosage for prophylaxis in adults is 1 Bactrim DS (double strength) tablet daily.

I take one regular strength bactrim daily and never use sunblock 
(I'm starting to itch thinking about all this now. LOL)

[vokz]

That is insane and must be a regional / US thing then, because here in Europe the maximum recommended adult dose for PCP & toxoplasmosis prophylaxis is one single 960mg (DS) tablet THREE times a week (e.g. Monday, Wednesday, and Friday) .. which still works out at less than you are taking on your supposed half dose.

It has been known since 1991 that this lower dose is equally as effective as the higer dose, but with far fewer side effects.

Even the GlaxoSmithKline patient information leaflet, from the drug packet, advises no more that three times a week.

[leatherman]

That is insane and must be a regional / US thing then, because here in Europe the maximum recommended adult dose for PCP & toxoplasmosis prophylaxis is one single 960mg (DS) tablet THREE times a week (e.g. Monday, Wednesday, and Friday) .. which still works out at less than you are taking on your supposed half dose.

It has been known since 1991 that this lower dose is equally as effective as the higer dose, but with far fewer side effects.

Even the GlaxoSmithKline patient information leaflet, from the drug packet, advises no more that three times a week.

I have never heard of the dosing schedule you are speaking of, nor do I find any information online suggesting that dosing schedule. I know the internet is not the best place for info but everything I can find and read about bactrim agrees with the once daily DS doseage (http://www.rxlist.com/cgi/generic/bactrimiv_ids.htm)

I should be getting my refill today or tomorrow and will look at the insert again (I've been taking this for over a decade so it's been a long time since I needed to re-read it). Can you point me to any links about your dosing schedule? If I could take less of ANY med I'd be happy to reduce the amount. 

[BT65]

Mikie, I don't know what the dosing is like in Europe, but here in the U.S., the dosing is one DS Bactrim once a day.  I know-that's what's I've been taking for years. 

[newt]

There are several recommended/used PCP prevention regimens in the UK eg:

Co-trimoxazole (Septrin), 480 mgs daily OR 960 mgs every 2-3 days .
Dapsone, 100 mg + Trimethoprim, 900 mg daily.
Inhaled pentamidine, 300 mg every 2-4 weeks.
Dapsone/pyrimethamine, 1 tablet twice per week.
Sulphadoxine/pyrimethamine (Fansidar) 1-2 tabs per week.

And then some.

There is no "official" regimen though. Depends on the clinic and patient.

- matt

[newt]

PS the AIDSMEDS lesson on PCP prevention sez (I quote):

"TMP-SMX (Bactrim™, Septra®) is the most powerful drug to prevent PCP from occurring ... Initially, one double-strength tablet of TMP-SMX every day in patients with less than 200 T-cells was the recommended dose. Today, many health-care providers recommend that it be taken three times a week instead. It's just as effective."

[vokz]

Pneumocystis Prophylaxis: Study Suggests Lower Bactrim Dose

[J.R.E.]

Today, many health-care providers recommend that it be taken three times a week instead. It's just as effective."[/font]

And if I remember correctly. The Dapsone was also similar. I was taking that, 3 times a week, until I was able to stop it alltogether.


Ray

[leatherman]

well, it's nice to know that me and my doc aren't insane like vokz suggested.  However I will discuss with him about lowering the dosage. Since I just added acyclovir, I'll be happy to drop some pills.  I'll really query my doc about this too. That report vokz linked to was published nearly 7 yrs before my doctor put me on this dosage.

[vokz]

Who suggested you were insane 

If you got that impression I apologise. I was expressing my views that recommending 960mg of Bactrim EVERY day was totally insane. If you are taking it daily it should be no more than 480mg (or one regular pill).

[leatherman]

That is insane and must be a regional / US thing then

PS the AIDSMEDS lesson on PCP prevention sez (I quote):

"TMP-SMX (Bactrim™, Septra®) is the most powerful drug to prevent PCP from occurring ... Initially, one double-strength tablet of TMP-SMX every day in patients with less than 200 T-cells was the recommended dose. Today, many health-care providers recommend that it be taken three times a week instead. It's just as effective."

it's not insane, it's not regional
the recommended dose is one DS tab a day

maybe I'm just touchy as bactrim has been the ONLY med to which I've been 100% compliant (even w/ some side effects). I was hospitalized with PCP once and pnuemonia once, and nearly died both times (even checked out AMA once to go home to die) and I don't EVER want to have that OI again. I LOVE my bactrim whether it makes me turn red, itch or puke - it keeps me outta the hospital.   

(I should probably mention here that my tcells have never gotten over 300 in the years since the hospitalizations. I'm lucky if they stay over 200.   So I keep taking the bactrim as if my tcells were <=200.)

after a decade (the offical 10-yr anniversay will be on my bday March 14th) being on Bactrim since the last pnuemonia, believe me though, I'll be happy to chat with my doc about reducing this to 3 times a week (the next appt IS that 10-yr anniversary and my 46th bday!). Maybe I'll itch less out in the sun by the pool this next Summer 

sorry for the taking up so much of your thread poz1970. I still stand by my earlier suggestion of perhaps reducing the amount of bactrim and dealing with a small amount of itchiness/sun sensitivity if need be. It all depends on how much YOU need  the med and how bad your reaction is.  I just thought I'd mention my story so you could consider a different option that totally giving up on a med that had worked for you.

[minismom]

Mini was on Bactim 3x/day for 3 days/wk until she developed a severe sulfa drug allergy.  Her t-cells were super low and her VL was through the roof, but she was never put on an alternative after her allergy developed.  The only "supplement" she was on daily was her liquid iron drops for her enemia.

Mum

[vokz]

it's not insane, it's not regional
the recommended dose is one DS tab a day

Sorry, but maybe the subtleties of the English language are totally lost on you then.

Back to the AIDSmeds lesson:

“Initially,” (once upon a time) “one double-strength tablet of TMP-SMX every day in patients with less than 200 T-cells was” (no longer is) “the recommended dose. Today, many health-care providers recommend that it be taken three times a week instead. It's just as effective”

It isn’t THE recommended treatment.

It WAS the recommended treatment and as the AIDSmeds lesson along with the 15,700 internet references to ‘Bactrim three times a week’ (not to mention the 1,050 for ‘Septrin’ and the 72,500 for ‘co-trimoxazole’) and similar articles at The Body, AIDSmap and Aegis all show, it is now (at best) the older one of several equally effective treatments.

[RapidRod]

I take TMP-SMX  x1 everyday and have been for over two years.

[BT65]

I'll have to talk to my doctor about lowering the DS Bactrim dosage then.  I'm all up for taking less pills!

[vokz]

J

I forgot to mention that the reason it would be good to find a way to make the conventional amoxiclav treatment work for your general day-to-day infections is that it is possible to develop resistance to co-trimoxazole (Bactrim). You want to avoid that as it is the best prophylaxis to have up your sleeve to protect you from PCP in the future.

The other caution for anyone reading this is that if your CD4 is below 100, then you may also be taking co-trimoxazole (Bactrim / Septrin) as a prophylaxis against toxoplasmosis. The US dose as a toxoplasmosis prophylaxis is 960mg (DS) daily .. so don't play with that before speaking to your doctor.