Prophylaxis

[Chipola]

Has anyone been prescribed or offered a prophylaxis to prevent opportunistic infections while on high dose predisolone (60mg) and methotrexate (15mg).

[PMRpro Ambassador]

Someone mentioned it recently - it is used in other forms of vasculitis in the UK I gather but not so much in the UK according to Sarah Mackie at Leeds. It ls also not that common for high dose pred and MTX to be used right from the start in the UK.

[Chipola in reply to PMRpro]

Interesting re high dose pred and MTX taken in tandem not common in UK. Why is this?

[PMRpro Ambassador in reply to Chipola]

I don't know - although Prof Dasgupta, the UK guru on GCA, has said a few times that he doesn't think it helps in GCA. Recently there seems to be a movement to use MTX in PMR cases - despite there being little real evidence as yet that it works reliably and patients have very mixed experiences with it. A few people DO do well on it and really you have to try it to know if it will help you, but there just doesn;t seem to be a culture of using it in GCA - especially, as I said, right from the start.

[DeepThought2]

Dear Chipola - in German, where I live, Cotrimoxazole is often prescribed for Pneumocystis jiroveci pneumonia prevention. I received it as long as my pred dose was higher than 20 mg.

[Towdy]

I suffer from AERd & CIU and adrenally insufficient. I had prophylactic azithromycin thru the winter to prevent chest infections. Now on biologic so stopped

[Viveka]

I was offered precautionary antibiotics when on 25mg, (down from 40, at first rheumy appt. Turned them down. I don't have any other medical conditions that would warrant it. She seemed a sensible rheumy till that point.

I have had a finger/nail abcess when back up on pred in a flare but it sorted itself out. Impacted wisdom tooth grumbles but settled down with taper.

[Pixix]

This was asked within the past week, you may want to search for it. I take antibiotics for five months of the year to ward off lung/chest infections. But I had an appalling 3 winters before that, & was referred from local hospital to a professor in charge of a major lung unit…a common cold was turning ‘very bad’ in two days, steroids & threatened hospital stays, & 8 weeks of sickness each time. The antibiotics are taken 3 days a week. I’ve no idea if they work, though, as suggested, we shield from November to February, & then have a month in Florida! I didn’t have PMR at that time, & steroid doses generally lasted 2 weeks.