Prescription antibiotic for GCA

[chanel2]

On my first visit to Rheumatologist she prescribed an antibiotic (Sulfamethoxazole) as I am allergic to penicillin, to take daily. Is an antibiotic usually prescribed for GCA or because of taking prednisone?

[DorsetLady PMRGCAuk volunteer]

Hi,

Not that I’m aware, and I thought we weren’t supposed to take antibiotics nowadays unless absolutely necessary.

Will be interested to hear others comments.

[chanel2 in reply to DorsetLady]

I should have asked her why at my visit, but I think I was just overwhelmed with all the information and hearing my biopsy was positive. I have an appointment with her next month so will ask her about this. Yes I agree with you, all you hear is antibiotics taken too often then when you really need them they won't work.

[DorsetLady PMRGCAuk volunteer in reply to chanel2]

Having read other replies, I can understand the “prevention” thinking, but I would say that’s being a bit OTT.

Deal with the infection when and if it appears- some get a problem, some don’t!

I saw a notice in my GPs surgery yesterday which specifically said “Don’t ask for antibiotics!”

Just heard on radio, that it has been suggested GPs prescribe honey rather than antibiotics for colds, virus etc!

[GCA1947 in reply to DorsetLady]

Dear Sue,

I expect the price of Manuka Honey will rocket now and its expensive enough at the moment. A spoonful of 10+ with hot water and lemon juice does wonders for colds and sore throats. But don't forget the garlic capsules. In a capsule that way you don't taste the garlic but get all the benefits. 90 capsules of Sainsburys odourless Garlic is £4.00. Sorry I thought it was a lot less in a recent post.

Best wishes

Colin

[DorsetLady PMRGCAuk volunteer in reply to GCA1947]

It’s surprising (or maybe not) that Mother Nature has a lot of the answers. Trouble is, mankind gets involved and has to make a profit!

[Mikb]

I believe I was on antibiotics when I was first diagnosed. I think it was explained to me it was because of compromised immune system at higher doses of prednisone (80 mg). I can't remember at what dose of pred I was told to not take it anymore. Sorry. Not much help but I had serious pred head back then! Best of luck on your "journey" with this. By the way, I was diagnosed in May 2017 and I am currently down to 6 mgs.

[chanel2 in reply to Mikb]

I am on 60 mg dose of prednisone. Perhaps that is why but I will ask her on my next visit. Thank you.

[SheffieldJane]

I haven’t heard of this being routinely prescribed for GCA, she really should have explained her thinking. I wonder if she thought that you possibly had some sort of infection?

[chanel2 in reply to SheffieldJane]

I don't think she thought I had any sort of infection, that wasn't mentioned. She also prescribed Calcium with vitamin D3.

[ConventCassie]

I don’t think I would take it “till your next appointment”. I would call immediately to find out why.

[gtate1914]

I believe because with prednisone your immune system is compromised and more prone to infections. I was prescribed Bactrim, but decided not to take it unless I had an infection, will cross that bridge when I come to it. Don't want to take anything more than I have to.

[chanel2 in reply to gtate1914]

Yes, I totally agree with your logic.

[enan-illuc]

Chanel2,

When I was diagnosed with GCA and PMR the Rheumy put me on an antibiotic until I dropped from 60mg of Prednisone to (I think) 30mg of Pred. She said it was for 'prevention' because of my weakened system. I hope this helps.

Enan

[chanel2 in reply to enan-illuc]

Thank you. This may be what she is thinking. I will find out when I go again next month.

[GCA1947]

Dear chanel2

When I was diagnosed in January 2014 but only with G.C.A. I was put on 60 mg of Prednisolone for four weeks then steady reduction over next eight months to 15 mg, but at this level my dormant Osteoporosis came back. I have Klinefelters Syndrome as well only diagnosed in 1996 by which time I'd had 7 rib fractures and a metatarsal break in my left foot. Nothing was said about any antibiotic, I had to suggest the aspirin, Calcium & Vitamin D can't remember when the was started but it's the only one of all my medications that actually tastes nice.

Best wishes

Colin

[PMRnewbie2017]

Hmm. This is an odd one? Sulphamethoxazole (SMX) is not usually prescribed on its own these days(UK). It is usually found in combination with Trimethoprim and then called Co-trimoxazole and used to be marketed at Septrin or Bactrim.

In the UK the British National Formulary restricts the use of Co-Trimoxazole to specific infections because there is increasing resistance to it. It is also associated with rare but serious side effects especially in the elderly.

If you are allergic/sensitive to penicillins there are other antibiotics which would be preferable, You could ask why Erythromycin, Cephalosporins or Doxycycline wasn't considered? You have to establish why the prescriber wanted to give you an antibiotic and SMX in particular, in the first place.

[chanel2 in reply to PMRnewbie2017]

Thank you for replying. I will take this up on my next appointment. I do not want to take unnecessary medications or why this particular antibiotic.

[arthur463 in reply to PMRnewbie2017]

Wow! -- Doc.

[Telian in reply to PMRnewbie2017]

I was given Septrin years ago it made me very ill and jaundiced.

[SnazzyD]

Id love to know their reasoning. So, which infections are they wanting to prevent? One antibiotic doesn’t kill all. So, the option is go broad spectrum to spread the net. The problem with that is it starts to become non-specific and can damage the beneficial bacteria which are vital in the control of our own potentially harmful organisms. Why not leave well alone and just be vigilant?

[PMRpro Ambassador]

The first (last) time this question was asked I emailed Prof Sarah Mackie and asked her why it would be done. Apparently it is a common action in certain forms of vasculitis when patients are on both pred and another rather more heavy duty immunosuppressant. She was very surprised at anyone considering it necessary for most GCA patients and was rather concerned at the idea I thought.

Like PMRnewbie and Snazzy I would like to know their reasoning - if it is for such protection it is pointless using a narrow-spectrum antibiotic like that and I would be most reluctant to take it. And using broad-spectrum abx is a rather silly approach as they kill nearly all known germs including the good ones. There is already thought that autoimmune disease is caused by the balance of the microbiome being messed up because of excessive use of abx - this would just compound the felony.

[chanel2 in reply to PMRpro]

Thank you for this information. I will take it with me to my appointment next month.