Is it time to switch things up?

Ive been on rifampin + mino combo for 4 months and recently added tindimax and a biofilm buster. I feel like I am 10% better and I was expecting to be much better at this point. Should I switch combinations or is it too early? Its already been 4 months and most of my symptoms are at full force. Ive heard that rifiabutin is stronger than rifampin. Is this true and would it be smart to switch or wait another month. I took a year off school so all I am focused on is treating treating treating. I really want to get back to 100% but I don't know if this combination will do it for me. Does anyone know people that have gotten back to 100% or somewhere close to that?

Girlie that is awesome to hear you are almost back to normal. Is 4 months of rifampin enough to determine if its going to work?

I have herxed and improved a bit physically but my psych symptoms have probably gotten worse or are still the same. I will talk to my doctor about switching to rifabutin

many LLMD's set appointments around 2months apart at the start of treatment and have no issue switching to a different abx combo if at that time there is no significant response

i have been ill for 6 years now and i know 10% can seem like a lot when you are at your worst - but generally - for most patients i think this points to some significant response is expected inside 2 months to signal that you are on the right track - and if not a change is probably worth trying.

i know some conditions are harder to treat than others - i read that lyme on its own usually responds pretty quickly and is easier to get symptoms under control - but keeps coming back when abx are stopped. whereas bart tends to be hard and slower to treat / get symptoms under control from teh get go - esp after long term infection.

as so often with this group of illnesses - its not cut and dried - you have experienced a little improvement - but nothing dramatic and its been 4 months - perhaps this signifies bart or similar ( brucella, etc ) if it were me i think i would be looking to make a change - as girlie says - if rifampicin was helping - rifabutin will be active also - so nothing to loose there.

what is clear is that the same abx protocol does not work the same for each patient - many research papers have been published now that highlight 2 seperate clear reasosn for this
1st - antibiotic concentrations vary from person to person dramatically - according to some studies by up to 100fold - even when taking the same dose
2nd - different strains of bacteria ( specific studies on both bart and borrelia) have different antibiotic susceptibilities - and this can vary by a factor of 10 from strain to strain of the same species

this is pretty surprising when compared to the standard dose for all type approach used in conventional medicine - and whilst there are general classes of abx and general combinations typically tried for each infection - we should not think this means that combination will always be effective for every strain and in every person. that's a kind of reductionist thinking and nature just doesn't work that way.

there are however many possible combinations to try

perhaps try the rifabutin for a month or so - and if no significant change perhaps look at other bart combo's or adding persister drugs to your existing one - oil or oregano, methylene blue, nitroxoline etc

I've been dealing with Bart / Babs / Lyme for 3 years now and Bartonella is the hardest by far for me to treat effectively.

I've had to use 3-4 and even 5 drugs at once to get results. When I find a mix that works it normally goes like this, initial improvement and then a strong and powerful herx (not always but usually).

I used Mino / Bactrim (2 drugs in one) and Rifampin for 2 years straight (yes I should have rotated sooner) to get to 90% of my health back. I also mixed in liposomal oregano oil. When I stopped the drugs my symptoms returned within hours so I suspect the persister forms were not affected by this combo. Then I switched to Azithromycin / Rifampin / Pyrazinamide and herxed very, very badly which indicated to me I had a lot of the germ still inside me (eyes, ears, CNS and brain).

I have now switched to Clarithromycin / Rifabutin / Methylene Blue based upon Dr. MR advice. So far so good and I can confirm the Rifabutin is much stronger than Rifampin. Seems to get into the brain and CNS better in my experience. My only concerns are this mix does lower my WBC counts so I am monitoring that closely with bi weekly blood tests.

Carl - based upon my sample of one (me) I do not believe they develop resistance to Mino when combined with other drugs but I do think that once you have killed off the weaker ones the remaining germ (especially persister forms) remain behind and can quickly replicate.