Posted , 14 users are following.
My Rheumtologist went to a conference and learned that long term people on Prednisone should be taking a low dose of antibiotic. So she has me taking a Sulfa drug three times a week. Anybody else hear this?
1 like, 13 replies
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Silver49 DebbieHurts
Posted
I've not heard of that. Did she say what the reason behind it is? I know a few people with PMR and nobody has mentioned that.
EileenH DebbieHurts
Posted
A similar question was asked some time ago and I asked the rheumy with whom I am a patient research partner - she said that it is done for some forms of vasculitis where the dose of pred is high but she doesn't know of anyone who does it for patients on pred for PMR. Personally, nothing would persuade me to take a sulpha drug on that basis without some very good clinical trial backing . I take enough as it is.
This
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4751577/
suggests to me that the infection rate isn't that different in patients on corticosteroids whether they take abx or not but that it is important to monitor patients and not delay use of abx when required. I understand the risk to be for patients with RA on steroids - and PMR isn't RA.
I wonder if this
https://www.pharmacytimes.com/contributor/alexander-kantorovich-pharmd-bcps/2018/08/when-to-initiate-pcp-prophylaxis-in-patients-managed-on-long-term-steroids
relates to her desire to use a sulpha drug? And they say quite clearly I think that it may be appropriate for patients on above 20mg/day but that it can be stopped once the patient is down to 15mg and under. And that the numbers that this opinion is based on are limited.
margaret22251 EileenH
Posted
are you saying if you have been told you have RA on steroids you should take a sulpha drug, i dont want to take anything at the moment. Nobody has mentioned this to me.
EileenH margaret22251
Posted
I'm not - think it is very OTT! Only at high doses of pred taken for a long time anyway - and pred is rarely used long term in RA. And there isn't that much evidence. And what is may well have been funded by Big Pharma to increase their sales....
margaret22251 EileenH
Posted
thank you , by the way the arnica is hhelping the bruising, i also put some on my feet and they feel easier.
nick67069 DebbieHurts
Posted
I don't recall what dose you are now. When I was diagnosed with PMR, and given 15mg as starting dose, I was also put on antibiotics and omeprazole for the first 4-6 weeks while the pred dose was above 10 mg by rheumatologist. By the end of that period my stomach and guts cultures were completely destroyed and I could not hold food. Lost several pounds too. I stopped taking both and it took almost a week before I recovered.
Sometimes the prevention is worse then the illness it is protecting you from.
Anhaga DebbieHurts
Posted
Honestly I'm shocked to hear this. Given the world today with super bugs and antibiotic resistance and the general feeling that antibiotics should be prescribed as little as possible this seems completely out of line. I'd think it would be better to catch any serious infection at the beginning with an antibiotic which will target the specific infection. But I'm not a doctor and I don't know your specific situation.
Eat a lot of fermented foods if you plan to continue this, especially between doses so there's a chance for your gut to repopulate.
ClaireJG DebbieHurts
Posted
Since starting on pred in September 2016, the only infection I've had is one viral infection (a very light cold). Absolutely nothing else. I am quite cautious of infections though, using antiviral foam, antibacterial gel and vigilant handwashing at every opportunity. I avoid touching handrails if possible and I always wash my hands before eating. I also take Echinacea at the first hint of a cold. I really wouldn't want to take prophylactic antibiotics as I'm so aware of antibiotic resistance. Obviously if I succumbed to a bacterial infection I would have no choice.
EileenH ClaireJG
Posted
Beware - pred may mask the inflammation many infections cause and so you underestimate the severity.
And be careful with echinacea - it is not recommended alongside pred, which is an immune suppressant to calm down your body attacking itself.
ClaireJG EileenH
Posted
Good advice. I certainly didn't know that about Echinacea. I'll steer clear of that and just keep trying to avoid infections. Sadly, I have quite inconsiderate colleagues...
EileenH ClaireJG
Posted
If it has worked for you so far there is probably no reason to stop - just be aware.
The Germans have it right - get a cold/flu, go to bed until better. Do NOT infect the rest of the office and be a martyr...
Harrie4 DebbieHurts
Posted
I am also shocked. Was the conference sponsored by the pharmaceutical industry? (I know, I know: arent they all?)
Closer to home -- and now that I've got that out of my system -- I had carpal tunnel release done on my left wrist last week and both my GP and the plastic surgeon nixed a just-in-case run of antibiotics (due to the immunosuppresent effect of pred) . They explained that the pharmaceutical companies arent investing in the development of new abx so the protocol is to wait and see. I'm at 6.5 so it may be different for anyone over 10 or 15 mg. The wound is healing nicely, BTW.
I'd have to see some highly probative literature before I'd take those drugs
on a just-in-case basis.
jo66120 DebbieHurts
Posted
My husband has PMR ans the last time he saw the doctor he asked about antibotics. He was told that he does not give them for PMR but some of his RA patients do take doxycycline. There is a study called roadback.org that discusses this. My husband was taking the usual 15 mg. pred. and 10 mg. methotrexate. He has had PMR for 9 months. He is now down to 5mg. pred. and 1 methotrexate pill ( 2.5 mg) The MTX gave him problems. When he was takine 4 pills ( 10mg) he had trouble remembering things and felt like he was in a fog, but even though he tapered down the pred. to 5mg. he still was in the fog feeling. The fog feeling started to go away when he cut down the MTX. His "brain" is much clearer todday.
When this PMR started his doctor had him dividiing his pred. doses to 2 times a day. So in the morning he was taking 8mg. and after dinnerm he took 7mg. , by doing this it helped him thru the night and of course he was taking his MTX once a week along with folic acid every day. He continued to take the pred. tapering very slowly. It took alot of work to do this because he had rx's for 5mg. preds. and 1mg. preds. To begin tapering the prednisone he would cut 1/2 a mg. every week. One week he would take it off the morning dose and the next week he would take it off the evening dose. If he noticed more pain then he would hold and wait until things would calm down and kept tapering. I hope all this is understandable. His biggest problem with this PMR is in his hips, he felt like his hips were not attached. As he got better he could walk more and he is walking better.