Antibiotics & immunosuppression

[Fennella02]

Hi. I am currently on a hefty dose of Klaricid for a deep infection to my foot but don't know whether I should discontinue the Mycophenolate until the antibiotics are finished. My wbc is always low but this doesn't seem to affect me adversely. I haven't been able to get an answer from the surgery whilst my GP is off and my next dose is overdue. Many thanks. Clare

[misty14]

Hi Clare

Sorry to read of your nasty foot infection. Nightmare coinciding with GP holidays!. Have you got a Lupus nurse you could ask or leave a message for your Rheumy explaining your problem and GP away?. X

[EOLHPC]

Sorry you've got this bad infection, Clare. And I think misty's answer says it all, because this judgement call should be based on your individual history, of which your clinic team should be well aware.

For what it's worth, my WBC is always low & I've been on daily hydroxy 400mg + the relatively low dose of myco cellcept 1000mg per day, and have been managing recurrent persistent pyelonephritis/UTIs & mouth infections since last November without any of my Drs, nurses, consultants instructing me to stop myco. BUT I have kept vvv close to all of them, always imagining they'd tell me to stop daily myco. Finally, months into this ordeal, my GP wrote to my head of rheumatology asking for advice generally in treating my infections & maintaining my lupus meds. The reply was that so long as the infection was responding positively to antibiotics, the course of antibiotics should be extended even after the infection seemed to be over...as a prophylactic. I was & still am perplexed by this advice, and intend to ask about it at rheumatology clinic later this month. At one clinic appt last winter, a rheumatology reg did suggest stopping daily myco if & when an infection wasn't responding to antibiotics, and had symptoms including significant fever....but, as those infections last winter/spring did respond to antibiotics & only included slight fever at the top end of the proverbial "normal" (typical me), I had no cause to stop myco

Wishing you over this infection pronto! xo

[Purpletop]

I agree with Barnclown's advice - don't stop myco unless you see the antibiotics don't work.

[Fennella02]

Thank you Misty, Barnclown and Purpletop

When I had my last course of antibiotics, again a double dose (my GP isn't taking any chances!!), she stopped the Mycophenolate as a matter of course but this time I forgot to ask. I suspect her actions last time we're promoted by my chronically low WBC.

Late into yesterday evening, one of the more 'senior' GP's eventually called. It was immediately apparent that she didn't know what Mycophenolate was when she asked me what day of the week it was next due. She didn't seem confident at all about DMARDS in general and was bumbling uncertainly - rather unnerving really and was clearly not the right person to be taking advice from! I played safe last night by missing my dose of Myco and planned, as Misty suggests, to email my rheumatology nurse but, as my foot does seem a little better today, I think I am safe to resume. I only emerged from what I think was a flare last weekend so am reluctant to start another one especially as my eye is playing up again today which tends to be a warning sign. I had a tetanus jab too and I find that vaccines tend to trigger a flare.

I'm really grateful for your replies, I'm bored of hobbling and looking forward to getting some proper shoes on again! Thank you again. Clare x

[EOLHPC in reply to Fennella02]

Wishing you all the vvv best with this....apologies + I'll totally understand if you'd rather not go into details, but:

is it a soft tissue infection (e.g. am hoping it's not in the bone).....and was the choice of antibiotic based on a lab sample....and how long have you had this infection?

PS I take whopper doses of cefalexine for 2 weeks min when I have my urinary/kidney infections (& antibiotic associated diarrhoea/colitis is becoming a greater prob for me whenever I take antibiotics...which I usually do at least 1x per week (nitrofurantoin 100mg))

[Fennella02 in reply to EOLHPC]

Hi Barnclown

The infection is from a puncture wound to the sole of my foot, no bleeding, probably 1" deep and the pain is at its worst some 4" away, in my toes. It was very aggressive so my GP took it seriously and ordered me to bed but, when you can't walk at all, there's no point in not obeying! I wouldn't think it's in the bone but I expect that's what she's trying to prevent. It only happened on Sunday so early days and I'm quite tough where infections are concerned.

The choice of antibiotic was based on what she prescribed for me last time (pneumonia) and I have had it for pyelonephritis with excellent results. On reflection, they give it to me for every infection!

[EOLHPC in reply to Fennella02]

Right! Sounds vv good! (+ super inconvenient!!!!)

Hmmm...again, for what it's worth: back in the bad years before my sle was recognised, a deep puncture wound to a finger landed me in hospital on IV "detol" for 3 days with the tendons throughout my hand infected...so am vvv glad your medics are duly cautious. The pain was extraordinary...and by then I'd become a true toughie due to years of severe spine pain