Rifampin + Bactrim?

Hi,

Has anyone tried Rifampin + Bactrim together and had good results from it?

I have been on Rifampin for 2 yrs with very little improvement. Recently I have been taking Rifampin 900mg, Azithro, mino and tinidazole (tinidazole is pulsed). My dr told me to increase Rifampin to 1200mg and add Bactrim. I'm nervous about this combo because Rifampin and Bactrim decrease blood levels of each other. I don't want to jeopardize either of those drugs.

Any responses would be appreciated!

Thank you.

So you're going to be on Rifampin,azithro, mino, pulsed tinidazole and now add Bactrim?

That's a lot to be taking daily....

Maybe talk to your LLMD about pulsing more than just the tinidazole. What if you were to just add bactrim in M/W/F?

LLMD MR prescribes Rifampin with Bactrim. (He is an experienced LLMD that has an online treatment book that I subscribe to)

LymeBasics said...
If you don't respond to these antibiotics you should look into other issues as well:

Allergies/Diet
Thyroid + Adrenals
Gut health

Babesia
Bartonella can become resistant if you don't respond to Rifampin, Rifabutin might be an option to switch. And take bactrim next to it. You can drop the azithro and keep doing the mino.

Pulsing tinidazol is not necesarry on the bactrim, rifabutin, minocycline combination. You could try dapsone instead of tinidazol or PZA if you really want another persister-drug next to it.

tinidazole is a cyst buster and is often prescribed by LLMD's.
I wouldn't drop that one.

Girlie said...

LymeBasics said...
If you don't respond to these antibiotics you should look into other issues as well:

Allergies/Diet
Thyroid + Adrenals
Gut health

Babesia
Bartonella can become resistant if you don't respond to Rifampin, Rifabutin might be an option to switch. And take bactrim next to it. You can drop the azithro and keep doing the mino.

Pulsing tinidazol is not necessary on the bactrim, rifabutin, minocycline combination. You could try dapsone instead of tinidazol or PZA if you really want another persister-drug next to it.

tinidazole is a cyst buster and is often prescribed by LLMD's.
I wouldn't drop that one.

Tinidazole only works as a cyst drug on Borrelia. But Lewis already showed you cannot achieve MICs to have effect on Borrelia persisters with metro/tini in vivo. I see the study is already shared here. Bartonella doesn't have these enzymes that convert Tinidazole or Metronidazole into active compounds.

http://lyme-basics.com/lyme-basics/chronic-lyme/

I've written about its effect.

Since Dapsone also works on Lyme biofilms and persisters in combination with rifampin and minocycline I wouldn't mind the tinidazole. (Zhang has found this 3 drug oral combination to be most effective against Borrelia persisters.)

Zhang also found bactrim has effects against Borrelia persisters (also a sulfa-drug just like Dapsone).

So combining bactrim, rifampin, minocycline and pulsing dapsone instead of tinidazole would work better against all involved infections.

It covers intracellular Bart, Borrelia in all its forms, will have effects against Babesia (Dapsone, minocycline, bactrim and rifampin all have effects on Babesia) and Dapsone also has effects against auto-immunity and is a good drug for certain skin and mouth ulcers...

These are the newest insights into treatments...

Post Edited (LymeBasics) : 9/24/2017 3:49:23 PM (GMT-6)

Lyme-Basics -- can bactrim be added to rifampin? or does it have to be combined with rifabutin?

Thanks Rikki!

I'm treated Bab for 2 yrs before starting Rifampin and didn't make much progress with that either. that's when i switched to Bart (i have a + test for bart). bab is still an issue. i'm hoping the bactrim will help. there aren't many bab drugs that you can take while on rifampin. i recently gave up on alinia.

are you seeing Dr J? if so, are you getting good results? i'm thinking of going to see him.

good luck with your treatment. hope you feel better soon.

thanks for replying to my post!

rikky - to answer your question re what i did for babesia.
malarone, amox, augment, biaxin, plaquenil daily. flagyl pulses
malarone, bactrim, biaxin, plaquenil daily. flagyl pulses
clinda + quinine for 1 week - had to stop
BAB1
BAB2
malarone, bactrim, biaxin, plaquenil daily. flagyl pulses
malarone, amox, augment, biaxin, plaquenil daily. flagyl pulses
malarone, mepron, azithro (this one was pretty good)

than i got fed up with the slow progress and switched to Bart.

i have been avoiding herbs for a few years because they give me elevated LFT. for some reason I can tolerate 6 abx concurrently, but 1 drop of BAB2 or 1 pill of allicin gives me elevated LFT.

i plan to try integrating herbals again next week since my liver has been really good for a while now. adding houttuynia next week.

thank you for your help.

so really the only things you took the entire time for babs was was malarone, mepron, bactrim and plaquenil. bactrim and plaquenil aren't going to do much for it.

flagyl is said to be anti-parasitic but once again won't do much for babs.

malarone and mepron aren't interchangeable they do have different action on babs even though both have atovaquone. malarone did little for me mepron was better.

seems mepron was working well for you maybe you need to stay on that for a while? (not sure how long you used it). i've been on 2 tsp 2x/day for 7 months and counting and i still got it. Dr. J says you have to stay on it until its gone and there's no timetable for how long that will take.

i also didn't see any cephalosporins in your history. cefdinir is considered a superior abx to the others per many prominent LLMD's for lyme and as a combo for babs. for me the macrolides did nothing for me (zithro, biaxin).

doxy actually hit my bartonella pretty good when i first paired it with rifampin. go figure.

everyone is different hence why its good to mix abx's up sometimes.

let us know how you fare with the herbs.