Question on dosing Rifampin & Zith w/ plaquenil.

There are various dosing for rifampin, azithromycin, and Plaquenil. It really depends on a few factors, mainly depending on what your doctor recommends.

I think the standard dosing to minimize side effects and keep effective benefits of the medications is 500 mg azithromycin daily, 600 mg rifampin daily, and 400 mg Plaquenil daily.

The dosing of these is another thing. Some doctors will argue that for rifampin, you just take it 600 mg once a day which will create a better blood spike of medication and deliver higher concentrations to the tissues in your body which will make it work better. Others will recommend 300 mg of rifampin twice a day 12 hours apart from each other which will keep rifampin in your blood longer, but this lower dosing may not penetrate into deeper tissues as well or the brain. Another point... Higher doses of rifampin work better... For example the standard treatment for tuberculosis is 600 mg rifampin... But it was found that it can be cleared faster with 900 mg dosing, and even faster with 1200 mg, 1800 mg daily was found to work the best. (I can't remember the study I read or how long... but it cut the treatment time by at least half) BUT there may be some people with dosing this high who may have elevated liver enzymes. Also I read another post of someone who permanently cleared a bartonella infection in 3 months with dosing of rifampin 900 mg twice daily. She claims the treatment was a bit rough from side effects of the rifampin, but it worked and she is done now. (Please don't take me as a doctor though I'm just speaking from experience reports I have read, and research studies which I can't remember where I read them from lol).

1 very important key point about rifampin I have learned from experience though... It is FAR better to take this medication on a completely empty stomach. This is the most important thing I have learned in my experience taking rifampin. It is more important to take this antibiotic on an empty stomach than other antibiotics. What happens is rifampin has a high affinity to bind with proteins and food... so if it is taken with food, it will turn your poops reddish brown... but you are essentially just pooping it out! You will know if you are taking it right if your pee is really orange about 2 hours or more after taking the medication. To make it the most effective, it should be taken at least 1 hour before eating your next meal, or 3 hours after you have eaten your last meal.

I find taking azithromycin on an empty stomach is no problem for me either. Azithromycin has a very long half life in the body of about 68 hours. So the medication stays in the tissues of the body for a long time. Again doctors have various opinions of the dosing on this... either 250 mg twice daily, or 500 mg once daily.

For me personally I just take the medications all together once daily as I find this is more convenient and less damaging to the GI tract. So I just take 600 mg rifampin with my 500 mg azithromycin all at once, one time daily. I have been doing this for over 3 months now and it seems to be working. I then just take my probiotics before bed. I found my treatment is simpler like this.

I just wanted to say there is another person who beat bartonella by simply alternating day by day taking 600 mg rifampin, then the next day taking 500 mg azithromycin. She did this for 6 months, and apparently it worked! I don't know if I would want to try that myself as I'd be scared of the bacteria becoming resistant, but apparently it worked! Azithromycin does have a long half life.

As for the plaquenil... I'm not sure if it helps bartonella or not... however it has been found to help slightly with lyme. But one thing it does do is make the azithromcyin work far better intracellularly. It alkalizes the cells slightly. Plaquenil has a very very long half life in the body and stays for 1-2 months in the body. The 400 mg dose daily was found to be the most effective to keep the eye related side effects to a minimum while still keeping the medication effective. But some people have prescribed it as 200 mg daily and still find this to be effective. I found this medication to taste very bitter! I took it with food to help get it down.