mtx and antibiotics and surgery

[lindyloo2018]

Hi everyone

I am in a double whammy

rhuemy says stop mtx for antibiotics , stop mtx 1 week prior to surgery and then the week of surgery. presumably to aid recovery but I'm not sure if it's because of drug interactions also.

I have a large blocked sebaceous cyst, gp says it's infected blood results say too high wbc and neutrophils, so I took antibiotics flucloxacillin and stopped mtx.

1 week after antibiotics blood results still say too high wbc and neutrophils (0.5 under max range for each). is it still infected? don't know, seeing cyst consultant next week.

I may need different antibiotics, blood results have never been like this even when temporarily stopping mtx for surgery before, but I have had 2 surgerys's and stopping mtx this year already and it's catching up on me.

it I need more surgery next week will be more stopping mtx - it will mean I will have missed 3 weeks mtx - that's too much/ too risky.

the antibiotics interactions are on the NICE website bnf.nice.org.uk/interaction... as are other drugs.

if anyone has any ideas for me to avoid missing my mtx this week that would be good.

but I am in a double whammy, if infection - take antibiotics, if surgery - take antibiotics, either will mean missing my mtx for this week.

thanks

[Fra22-57]

the only thing I know is that these strong drugs lower your immune system so when you get infection or your body needs to heel they will prevent that so you need to stop the drug.When I had shingles I had to stop my biologic for three weeks which then was a catch up for my body to start helping me with the rheumatoid arthritis struggle.You could ask your rheumatologist for more answers.Hope you are soon back onto the road to recovery

[PSAWarrior28]

I recently had to stop methotrexate for 4 weeks. I was on antibiotics and had a bacterial infection. I was advised by rheumy nurse to stop while on antibiotics and one week after the course was completed. Obviously I've gone into flare and now dealing with the consequences.

[lindyloo2018 in reply to PSAWarrior28]

Hello - thanks for your reply, did your wbc and/or neutrophils increase when you went into the flare ?

[helenlw7]

I can’t advise you whether you should stop mtx or not, but my situation is that I have severe RA, asthma and another lung disease, bronchiecstasis. I was getting lots of chest infections, so my lung consultant had a meeting with my rheumatologist, and since then I have been on an antibiotic, Azithromycin, 500mg 3 times a week, along side mtx.

[lindyloo2018 in reply to helenlw7]

Hi - that's useful, what other RA meds are you taking aprt from methotrexate ?

[helenlw7 in reply to lindyloo2018]

As well as methotrexate, I’ve had two biologics, Etanercept which worked for over ten years, and Adalimubab which didn’t work at at all. I started a JAK inhibitor, Baricitinib, in February. It started working almost straight away. I also take 10mg of steroids, Adcal and co codamol.

[lindyloo2018 in reply to helenlw7]

gosh that sounds heavyweight, how on earth do you manage that lot, you must have a good rheumy

[helenlw7 in reply to lindyloo2018]

My rheumatoid is a lovely lady. She’s only the second one I’ve had since diagnosis. She’s seen me every six months f2f , even during the pandemic. I also have 4 inhalers and a tablet for my asthma, and several other meds to relieve the side effects of some of the others.

[Sunshinereturns]

oh I sympathise. I feel totally resistant to stopping my MTX for any reason and would almost rather cope with other complications but I appreciate that is probably an unrealistic viewpoint.

[Leics]

I do so feel for you to be stuck in that situation. I’m currently on Mtx and have to take prophylactic antibiotics every day as my immune system is pants frankly. I’m only on a very low dose of mtx and antibiotics but I take the antibiotics daily even on mtx day. I know they’re not the best solution as they do make side effects slightly worse but I do t have a choice in that either. I’d contact rheumy team and ask for their advice but the reason you’ve been asked to pause is so your immune system can help you heal post surgery.

[Retirednhs]

I can understand your confusion I agree you should contact your R A team its usual to stop MXT when on antibiotics as neither works properly when you take both I was advised I also have had a long dose of antibiotics and I am due to have surgery on 24th the advice then is stop for two weeks after so ask them to sort it for you

[lindyloo2018 in reply to Retirednhs]

many thanks for your help

[lindyloo2018 in reply to Retirednhs]

I have high wbc and neutrophils count suggesting infection but not rheumy or gp will prescribe antibiotics as they say being that close to the top of the allowed range is no problem. I am due to have my covid booster this week and am frightened that it will push the wbc etc counts even higher .. help!!

[lindyloo2018 in reply to Retirednhs]

Hi re surgery I was told to stop 1 week before surgery and the week of surgery, restart RA drugs after finish post surgery antibiotics.

how long were you off your meds whilst on antibiotics ? did you get a flare for being off your meds? how long does it take for the flare to show ?

thanks

[lindyloo2018 in reply to Retirednhs]

please could you tell me what antibiotics you were on for 2 weeks?

[Retirednhs]

Good luck, go with it, same people have had reactions but most haven't just a tender injection site and RA dept would not let you go for it if they were worried aboutits effect on you

[lindyloo2018 in reply to Retirednhs]

Hi - thanks - Rheumy has backed off - always days ask the GP now, does not want to get involved, has only said take my mtx, has not said anything about the covid vaccine..

[Retirednhs]

Hi, l didn't take my RA meds whilst on antibiotics and 1 or 2 wks after finishing but it depends on which ones you are on . All together it was 4 wks and yes you can gradually move into a flare but it should soon clear once you restart your meds. As you go down the path of RA you will soon realise how your body works and how to care for yourself but always remember your RA dept will help you out if you have any concerns

[lindyloo2018]

ok thanks, which ra meds do you take?

[Retirednhs in reply to lindyloo2018]

l am on for life steroid maintenance dose plus methotrexate injection week l was on monthly Toczilimab infusions until 18 months ago l am now on Rituximab infusions 6 monthly . There are many types of treatment and its trial of different ones until the right combination is found for you not easy at first but you will get there and stress can cause flares as well so try and stay calm talk to your gp about your problems as you have been told l don't know how your area works but our lovely RA nurses have a telephone system you can ring every weekday and they ring you back askif your RA dept has the same take

[lindyloo2018]

thanks, I have stopped hydroxy 3 months ago but my wbc and neutrophils and csr have shot up. I am wondering if thats lack of hydroxy or an infection. can't differentiate.

also was wondering about injecting mtx, does that save the liver with antibiotics ?

I have been very stressed in the last 4 months

[Retirednhs]

HI, l prefer the injections myself but you need to discuss this with your RA dept they are the ones who decide how you take it and the strength according to the other drugs you are on and what they feel is suitable for you. Every one is treated like the individuals we are according to our needs. Don't get stressed about your blood tests they will keep an eye on them and speak to you about them if they feel they are incorrect. Blood results have a wide range and a little raised or low result is not unusul. RA is not an easy thing to live with but stressing will not help you . Try to relax and give your meds a chance to work

[lindyloo2018]

ok thanks, I am on the co-amoxiclav now to see if it works before getting the cyst drained.

maybe best to get it drained anyway. so no mtx this week.

please could you tell me what anti biotics you were on for 2 weeks?

I have read that the max you can be on antibiotics is 2 weeks anyway ?

many thanks