Abx combination question

Quin said...
At the time, I was taking amoxicillin, clarithromycin, and valproate. This worked pretty well against borrelia, but the bartonella infection just got worse and worse.

Eventually I switched the clarithromycin for minocycline, and then I started getting a bartonella herx. Flu-like symptoms, and it smelled awful. Maybe not quite as bad as the smell of C.Diff, but bad.

Why did I get resistance? Probably because I got the bartonella from a cat. People give their cats antibiotics, and this breeds antibiotic-resistant bacteria.

And bart is hard to get rid of. After 4 months of minocycline, I did a PCR test, and it was positive for bartonella henselae. So I'm still on antibiotics.

When you say bartonella infection got worst and worst, what do you mean? More rashes? More neurosymptoms?

isitlyme said...
When you say bartonella infection got worst and worst, what do you mean? More rashes? More neurosymptoms?

Yes, rashes, fever, nosebleeds, felt out of breath.

isitlyme said...
How do you know that those werent herxes themselfs? Or did minocycline out them in the corner and zithromax not?

Initially I thought the hemolysis (dark urine, bloody snot) was a herx, but it just got worse and worse. It wasn't a herx, the bacteria were growing, and destroying red blood cells in the process. This was mostly associated with valproate use. I suspect that valproate does not kill bartonella, but stresses it in some way, which causes it to invade red blood cells more aggressively, or possibly just releases it from cysts.

Minocycline caused a very different effect, fever, stomach ache, and flu-like symptoms. This is a typical reaction to lipopolysaccharide from dying bacteria, and is expected symptoms of a Herxheimer reaction. The bartonella herx also smelled awful. I suspect this is due to ammonia and sulfur compounds, which bartonella is known to produce as a result of its distinctive catabolism of amino acids.

Strangely, I didn't notice a lot of smell when bartonella was actively growing, but it seems to release a lot of toxic stuff when it dies. Some other bacteria can also produce a foul odor, especially C. Diff, but I don't seem to have any particular symptoms of C. Diff infection. I got some diarrhea from the antibiotics, but not as bad as would be expected from C. Diff.

I was taking clarithromycin when I started getting hemolysis and rashes from bartonella. The clarithromycin didn't seem to do anything to stop bart. Since Zithromax (azithromycin) is chemically similar, I did not try taking that. I figured that if bartonella was resistant to clarithromycin, it would probably be resistant to azithromycin also.

As for why I was taking the valproate and clarithromycin, it was because it seemed to be effective for treating borrelia burgdorferi, and I was having less symptoms of Lyme disease. In particular, the muscle and joint pain resolved. I also took amoxicillin, which didn't seem to have any effect on bartonella either.

isitlyme said...
Red urine??? Did you checked liver enzymes that time? Red urine is usually sign liver damage.

Red urine? Only from rifampin.

Bartonella caused dark yellow urine. This is due to bilirubin, which is formed from the breakdown of hemoglobin when bartonella destroys red blood cells. My ALT, AST, ALP were fine.

isitlyme said...
Added zithromax low dose and bang rash on my leg, neurosymptoms ten fold. Twitching everywere, head jerks, i guess the bug didnt like that addition to cefixime and amox. Going to probably pop a 150mg sodium valproate tonight to shut down my brain.

That seems like a bart herx. You're lucky your bartonella infection was susceptible to azithromycin.

Sodium valproate mostly just made me herx. It also made me a bit tired and feel spaced out. Often the effects are not immediate though, it can take a while. I'm surprised it works fast enough for you that you can use it as a sleep aid.

It not really a sleep aid, it shuts my brain up.

isitlyme said...
https://academic.oup.com/jac/article/46/5/811/668607

[...] in our experimental conditions, only the aminoglycosides, and to a lesser extent doxycycline were bactericidal

This is consistent with my experience. Clarithromycin, amoxicillin, and rifampin did not work against bartonella henselae. Minocycline did.

Minocycline plus valproate worked better. However, when I took sodium valproate without minocycline, the bacteria did not die and I noticed an increase in hemolysis. This suggests that bartonella actively resists the effects of valproic acid, and invades the red blood cells to get the nutrients to do so. I suppose sodium valproate could be useful to get bartonella to migrate out of the nervous system. Is that what you mean by "it shuts my brain up"?

I'm not surprised. Valproate seems to make bartonella more susceptible to minocycline, I suppose it could do the same with azithromycin. Also, both valproate and azithromycin have a slow elimination, and can cause herxing several days after the last dose. I haven't taken N-acetylcysteine, but disrupting biofilms can release other bacteria.

The good news is that I'm getting a lot less herx now that I've gotten rid of most of the bacteria. So if this is working for you, then hopefully your herx will get less over time too.

Acute case of Bartonella - generally more easily treated than most of us - ie. chronic Lyme.

Llmd’s generally don’t use a cephalosporin unless it’s paired with something that specifically targets bart.
- Rifampin ... Rifabutin ...for example.

isitlyme said...
Yes, but it shows Bart can be susceptible to cephalosporin alone.

Possibly, although I wouldn't count on it. Bartonella is becoming increasingly antibiotic-resistant.

isitlyme said...
But two days ago i had the worst herx of my entire life after adding zithromax to cefixime. Never had that with ceftin plus zithro, or any other combination.

Is that normal? Shouldnt herx decline slowly as time goes by? I am getting worst after one year treating, because of that i am afraid that could have another disease wish as nothing to do with the infection.

I'd think that valproate + azithromycin + cefixime would be a pretty effective combination. I'm not surprised you're herxing.

I'm taking valproate + minocycline + cefdinir, and I herxed so bad from this I had to stop taking it for a while. I'm taking it again and the herx is not as bad now.

isitlyme said...
I have seen reports where cephalosporins failed and others where third generation cephalosporins was a sucess for bartonella. It depends on the person and the probability of getting a mutant resistant bartonella or not. This case was used with a gentamicina like abx with cephalosporin.

Patient 2.A 13-year-old adolescent boy presented with right axillary lymphadenopathy and a cutaneous skin lesion 1 week after a cat scratch [7]. One week after the initial presentation, fever, anorexia, and headaches developed. On day 17 after the cat scratch, the patient complained of dysesthesias, abdominal pain.. Treatment was initiated with ceftazidime and netilmicin administered intravenously for 10 days. Dexamethasone was administered intravenously for 5 days...The neurological symptoms began to resolve on day 7. Walking unaided was possible by day 12 after treatment initiation. Bladder function improved, and lymphadenopathy decreased...The diagnosis of CSD with transverse myelitis in patient 2 was based on the history, clinical findings, and antibody titers. Biopsy of the lymph node was not performed.

https://academic.oup.com/cid/article/45/4/e42/428639

This person initiated treatment 17 days after the cat scratch. And only got treatment for 10 days?

That is an acute infection...of bart.

Acute lyme is often treated with only one antibiotic like doxycycline and for a much shorter time than chronic Lyme... ie a few months versus many months to years.

Chronic is usually more complicated.

It seems all the symptoms reach a peak and then after 3, 4 days they only are milder, but always, always there, then suddenly they get worst and worst, and the worst is getting worster as time goes by. But yes they get milder then worst again, but the worst part is getting worster. For example the last time, 3 days ago, it almost fried my brain, i was even crying from nerves of this not going away, i didnt slept all night, took more 2 gabapentins, nothing, took valproate, nothing, couple of hours, took another 2 gabapentins plus one more valproate and even 2.5mg valium, slept a little but it was shirt lived. My head was jerking to both sides and to the back side violently as soon as i fell asleep, to wake up. And my head was painfull on trigeminal nerves on both sides. My thumb, index fingers twitch like crazy. After one day it was milder, i looked in the mirror and had a new rash on my back, Yellow spots on my legs. Its like i am dying slowly, i dont know how to feel know waiting until.it hits me hard until it kills me