Prophylactic antibiotics

[Viola1]

My rheumatologist wants me to go on Bactrim, three days a week, prophylactically in order to not contract some of the more obscure, dangerous illnesses such as pneumocystis. I’m on 60 mg prednisone for PMR/GCA with a plan to taper by 5 mg every two weeks if I tolerate that.

I’m wondering with the research might show about the prophylactic use of antibiotics and what this forum’s wisdom is about it.

Thank you for your help.

[gifford7]

Same here. My rheumy had me on bactrim 800mg 3da/week. I had side effects and he said OK to cut the dose in half. I was on 80mg pred and he said OK to go off the bactrim at 20mg pred, as I recollect. Link from the Mayo Clinic: ncbi.nlm.nih.gov/pmc/articl...

"Conclusion

PCP is rare among patients with GCA. However, this preventable infection is associated with significant morbidity and mortality.

Keywords: Giant cell arteritis, Pneumocystis jiroveci, Pneumocystis pneumonia, corticosteroids"

[Viola1 in reply to gifford7]

What side effects did you have? And did they go away when you cut the dose in half?

[gifford7 in reply to Viola1]

side effect from Bactrim--diarrhea but this also could have been caused by metaformin which i was on at the time. The lower dose helped. I no longer take either drug. I was concerned about the possibility of C. difficile and included yoghurt with active organisms in my diet daily. I'm in California. link:

ncbi.nlm.nih.gov/pmc/articl...

Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection

[PMRpro Ambassador]

The first time I came across this I spoke to Prof Mackie in Leeds about it. She said she had never come across it being done in GCA although it is a common practice in other forms of vasculitis where other really heavy duty immunosuppressants are used along with pred.

I've always been under the impression is generally a quite unpleasant antibiotic on the whole and it is associated with a moderate risk of developing a C.difficile infection. Which is also a very nasty infection and not so rare these days.

[Viola1 in reply to PMRpro]

Thank you! I will check into the C diff concerns.