Vimzor said...
If bartonella is resistant to clarithromycin, would azithromycin still work? Or are they too similar?
they are in the same class and act on the same mechanism so you would expect anything resistant to one would be resistant to the other - but in practices it doesn't always seem to be the case.
in any case - i would not worry about
resistance too much
Dr M the bart guru treats all his patients with clarithro and rifampicin - or sometimes rifabutin ( same class and mechanism as rifampicin) the large majority seem to get better
bartonella treatment is just typically long whichever drugs you choose - which could lead some people to assume its resistant - but if the guy who treats 1000's of Bart patients almost never finds the need to change to other antibiotic - i think that's a fair indication that true antimicrobial resistance in humans is rare - and its likely that this slow response is just a part of the nature of the disease.
bartonella is intracellular
- it lives inside red blood cells, white blood cells and cycles in and out of endothelial cells where it might be protected from antibiotics to a large degree
- and seems to form both persister cells
- and (recent evidence suggests) biofilms too
these characteristics are all a good fit with a slow response to antibiotics.
but a slow response due to the bacteria's chosen lifestyle is not the same as genetic mutation leading to complete antimicrobial resistance.
other slow growing intracellular infections also take 12 months or more of combination antibiotics
eg tuberculosis and leprosy - so bartonella fits the pattern pretty well
no disrespect to Quin and his experiences or theories intended - theirs is as valid an experience as any of us have - and i am happy that they shares it along with their theories of why it might be working for them.
But it is more of an N=1 trial and i think he would agree that we don't know how generalisable that is to the rest of the population.
so i am just giving another perspective as i think there is enough info out there that points to true genetic antimicrobial resistance of bartonella being rare.
And i think you already have enough worries without getting caught up in more over antimicrobial resistance.
to me it seems more likely that the explanation why some people recover and others do not is more to do with individual differences in immune system function rather than things like antimicrobial resistance.
ie the people who take every drug combination under the sun and are still sick - likely have more severe immune system dysfunction and cannot clear whatever is left of the infections that the antibiotics cannot kill.