Anyone used antifungals with biologics

[Runrig01]

Hi I’ve just completed 2 weeks of antibiotics for a UTI, completed second course on Sunday. Unfortunately on Saturday developed throat pain, by Sunday morning I’ve got white spots on my throat and tonsils, which has increased in the last few days. Currently waiting for GP to call. I had a fungal infection in my mouth 2016, which they thought was squamous cell carcinoma, but turned out to be chronic hyperplastic candidiasis which can turn malignant. Thankfully it wasn’t and responded to 3 weeks of antifungals. Last April it recurred in the same area and needed 3 weeks treatment again. This feels similar but different area. All my summaries say to stop biologics and MTX if on antibiotics or antivirals but no mention of antifungals. Obviously I’ll try and make contact with my team, just intrigued if anyone else has experience re this. It is so painful even swallowing drinks, I suspect it’s due to the 2 weeks of antibiotics.

[Jillyanne]

Hi, obviously contact your Rheumatologist but I take antivirals whilst on Rituximab with no side effects

[Jillyanne in reply to Jillyanne]

Sorry ignore my post 😂😂😂 got slightly confused 🙄🙄

[Runrig01 in reply to Jillyanne]

Hi thanks, I intend to speak with the team. I know with antivirals I have to stop, it’s just the antifungals it doesn’t mention. Thanks again 🤗

[Leics]

I don’t know the answer to your question I’m afraid but sending good wishes to you as it sounds like you’re going through it atm. I ALWAYS without fail have a probiotic if I’m taking antibiotics not at the same time of course so once a day between courses have a live yogurt or yakult or something similar. As a result I don’t suffer with thrush anymore but it used to affect me terribly. I hope you get some answers and some treatment too but a live yogurt may be a good natural start.

[Runrig01 in reply to Leics]

Hi thanks. I do take a live yogurt daily. It’s not thrush I get, it’s been biopsies previously and shown to be chronic hyperplastic candidia. I’m told it’s partly due to my immunosuppressants and the amount of meds I take that dry my mouth out. I’m already prescribed nystatin to use long term 1 week in every 4. My tongue is never an issue now. This seems to be as a result of 2 weeks antibiotics. I often take probiotics but forgot this time. Thanks again.

[Leics in reply to Runrig01]

I feel for you I wasn’t trying to suggest that the problems you have were down to thrush as you explained that you suffer with hyperplastic Candida but was just thinking that a probiotic may help to calm the discomfort. It can’t be any fun for you I hope they manage to sort treatment out for you or you get some answers re antifungals. Antibiotics can be a pain in the bum setting off other stuff wouldn’t be without them but dread having to take them.

[Runrig01 in reply to Leics]

Sorry, my memory is shocking since I had a stroke 4yr ago, I never remember what I’ve already said 😂. I agree much as they do wonders I hate when they are needed and we have to stop immunosuppressants and risk our inflammatory arthritis flaring. Will certainly not forget probiotics next time. Ironically I’m currently on my 1 in 4 week of nystatin, so my tongue is fine. Gargling 1ml over tonsils and throat is impossible though. 😂. On fluconazole for 3 weeks, can’t get through to my team yet, so will hold off my MTX tonight. Thanks again 🤗

[oldtimer2]

Fungal infections are common after antibiotic treatment unfortunately - and there doesn't seem any reason why you shouldn't start on anti-fungal treatment as soon as you can. Always worth asking the pharmacist about that sort of problem to check - they are the experts on interactions and if they don't know, they know where to look to check.

[Intheend]

I have nothing useful to add but just wanted to say how sorry I am you are in so much discomfort. I hope the Rheumy Team get back to you soon with advice re your biologic..You are always so kind and helpful to everyone else on this forum.

[Runrig01 in reply to Intheend]

Thank you for your kind words. Struggling to get in touch with the team, so will hold off my MTX tonight. Have 3 weeks of antifungals, so I suspect 3 weeks off immunosuppressants. Couldn’t happen at a worse time I’m off to Somerset in 2 weeks on holiday, which should involve a lot of walking. Plantar fasciitis has reared its ugly head this morning, having been off meds for 2 weeks already. So may be more restful than I planned, thankfully have an understanding hubby 🤪👍🤗

[Amnesiac3637]

I think a call /visit to a pharmacist- he or she should certainly be able to give you a definitive answer. Good luck and hope it all resolves very soon!

[Runrig01 in reply to Amnesiac3637]

Spoken to my regular pharmacist, but he says it needs to be my rheumatologist to advise. Thanks though

[Amnesiac3637 in reply to Runrig01]

Just goes to show that we all need a tame rheumatologist kept in a cupboard………😀 Do hope you manage to raise yours soon.

[kennethb]

Hi, eating live yogurt is a good idea & also drinking full cream milk which encourages mucus formation in the throat which attacks abnormal yeast infections.

[Runrig01 in reply to kennethb]

Hi yes I already eat live yoghurt. Unfortunately I’m lactose intolerant so can’t drink full cream milk. I tend to drink soya or almond milk, and my yogurts are generally soya based. Thanks though 👍

[Nadine-NRAS]

If you are unable to contact the rheumatology team, try the pharmacy at the hospital. If you still have no luck please call the Helpline on 0800 2987650 and we will contact the pharmacist on our advisory board.

[Runrig01 in reply to Nadine-NRAS]

GP had requested an urgent appointment to view my throat as he wanted confirmation it warranted the 3 weeks of antifungals. Unfortunately the dr I seen at urgent care was in a tiss because I had severe throat pain and take MTX, as it’s a medical emergency, due to risk of neutropenia. Despite me reminding him the throat pain is associated with the white spots and that I gave t taken MTX since 18/5, I was rushed off to A&E for urgent bloods. Thankfully as I had told him I wasn’t neutropenic, but had a white cell count confirming ongoing infection. The Dr I seen said to remain off for a further week and to restart once white cell count has dropped back down. So have my answer for now, and can confirm with the team re restarting. Many thanks

[Nadine-NRAS in reply to Runrig01]

Glad you have had some clear guidance, and I realised after I sent the message that with a throat as you described it, talking on the phone would not be easy, so I apologise for not thinking that through. I have been awake since 4.45am.As you have had this before, I am sure it has been suggested, but if not, ice chips can be very soothing. Put ice cubes in a zip lock bag and smash it with a rolling pin.