methotrexate and antibiotics

[Avon14]

Hello

I’m wondering if anyone can advise whether I should miss a week or two of methotrexate injections whist on a course of antibiotics?

For background information I was diagnosed with GCA in April 2021, started on prednisolone 60mg reducing until I relapsed in July 2022. I’ve been reducing again and now at 7mg prednisolone along with 15mg methotrexate (weekly by injection ) since October 2022.

I’ve also a chronic uti which I’ve had since April 2022.. I’ve had 4 courses of antibiotics to no avail but prior to the methotrexate. GP wants me to try antibiotics again but I’m concerned about the interaction. I’ve been having fortnightly blood monitoring but it has recently been transferred to GP monitoring every 3 months.

I’m not able to get a GP phone call to discuss for 3 weeks so wondered if anyone here has experienced similar?

Grateful for any information/suggestions.

[PMRpro Ambassador]

Well for a start you tell your GP practice this is an emergency and you need advice. And no, it is NOT appropriate to go to A&E. I'd even turn up at the practice and make the request.

Do you not have a rheumatology helpline? Not that that is much use on a Friday night of course.

Normally before you start MTX you get an introductory talk and leaflets about what you should do if you have an infection and need abx, Usually you are told to leave off the MTX injections while taking abx, The frequent UTIs are probably due to the pred but the MTX will also make them harder to get rid of because both pred and MTX suppress your immune system.

However - are they proven UTIs? Has the doctor sent a urine sample to the lab for a culture after doing a dip test at the practice? Or are you just having the symptoms of burning when urinating, urgency and frequency? Are you on calcium supplements? Sometimes we have the symptoms of a UTI but it is due to something called irritable bladder or to calcium grit in the urine irritating the inside of the bladder and urethra.

Another way to manage frequent UTIs is to take something called D-mannose - a type of sugar that flushes bacteria out of the wall of the bladder. It also helps to take it with abx,

healthline.com/health/d-man...

It is in cranberry juice which is why they tell you to drink that - but the capsules are much easier to deal with and you don't have to drink loads of juice!

[Avon14 in reply to PMRpro]

Thank you PMRpro for your prompt response. I do feel particularly abandoned by the GP practice and rheumatology. I received a text advising me that a prescription was waiting for me but obviously I couldn’t reply. The rheumatology helpline will respond and are helpful but this is usually in about 2 weeks. I did get a leaflet when starting on Methotrexate and I’ve checked, it just advises against one type of antibiotic. I’ve been prescribed pivmecillinam. I did get referred to a urologist and had a cystoscopy, all okay and had an ultrasound where they found a small stone on one kidney I have minimal symptoms of uti just feeling that I need to go more often. My urine is sent to lab and E. coli has been identified each time (currently 5 separate occasions). I have purchased d-mannose as suggested by the urologist, however, my rheumatologist didn’t think it would be helpful. I will try after this course of antibiotics. I will try again on Monday to speak to GP

So grateful for your support

[PMRpro Ambassador in reply to Avon14]

Your rheumatologist specialised in urology did they? Why did he think it wouldn't be helpful? Ask on this forum and you will get a couple of pages of recommendations! D-mannose does work, both to shorten the process and to prevent in future, If i get the first signs of a UTI, I take 3x500mg capsules of D-mannose, usually 3 times in the day and see how it goes - after that I usually take just one dose a day or 3x500mg separately. I;d take more but it is rather expensive here.

What is obviously happening is they aren't giving the right abx for long enough - some doctors are so terrified of abx they actually cause the problem they are wanting to avoid, They give not enough and not long enough, a few bacteria are left and after a few weeks they have multiplied enough to cause trouble - but this time, they have survived an attack by the abx and are now in training with experience. And every time the same thing happens, they are better able to survive the next abx.

[Blackcat1M in reply to PMRpro]

when I was given mtx nobody told me anything I just had to read and take good advice from this forum, there Is only one doctor who knows anything mtx and it’s hard getting to see him

[PMRpro Ambassador in reply to Blackcat1M]

You are supposed to be counselled about the effects, good and bad, so you can make an informed decision!!!!

[Avon14 in reply to PMRpro]

I think I did have a counselling session which was the nurse reading the leaflet. I asked about the evidence base and she said yes, for rheumatoid arthritis which I reminded her I didn’t have.

[Blackcat1M in reply to PMRpro]

All my rheumatologist said I would like you to try this and see if it helps.

The pharmacist gave me my book and said read it through that was it.

[PMRpro Ambassador in reply to Blackcat1M]

Absolutely disgusting, Nothing like informed consent ...

[Sharitone in reply to Blackcat1M]

Same here! There is NEVER any discussion, just a decision handed down from on high.

[MrsNails in reply to Blackcat1M]

When l first went on MTX l had to sign a Form (in triplicate) agreeing to the risks & possible side effects. (It was not dissimilar from the Form l had to sign when l went on Chemo) This was after a full explanation.

[Avon14 in reply to MrsNails]

I don’t remember signing anything. Although I did have an appointment with a nurse who basically read the methotrexate leaflet to me.

[Blackcat1M in reply to MrsNails]

No never signed anything like that.

I have learned so much from this forum that I am reluctant to try anything now before a good explanation, that’s why I decided not to have IV AA as I felt it was not explained properly to me .

Hope you are keeping well and having fun with your grandson best wishes x

[Avon14 in reply to Blackcat1M]

I do feel that this forum and my own research is essential. Where is the doctor you mention based?

[MrsNails in reply to Avon14]

Not sure if this reply was a question to me? But l saw a Rheumatologist in Wrexham as an Urgent 2nd Opinion on the NHS

Sadly, she is no longer with us having fallen in a climbing accident, she was a brilliant Doctor so it was a huge loss. RIP Dr Lim 🙏🏼

I still have my MTX Booklet - that she gave me with all additional information she wrote in by hand, apparently they don’t seem to issue these as a matter of course any more either……

[Avon14 in reply to MrsNails]

Thank you, Blackcat1m mentioned a doctor who is difficult to get to see but is the one who knows about methotrexate, just wondered if he/she is within travelling distance? I’m probably naive but isn’t this a rheumatology specialist med?

[MrsNails in reply to Avon14]

Sorry l hadn’t read further up - yes all Rheumatologists deal with Patients with RA & MTX was/is the first line treatment before other Meds are tried so they should know all bout the drugs as Medication is how most of their Patients are treated.

[Blackcat1M in reply to Avon14]

Hi when I said he knows all mtx I meant he knew what medication we could have and not to take it with antibiotics my apologies for misleading you into think he was a expert

[Avon14 in reply to Blackcat1M]

No worries at all, thanks for clarifying.

[MrsNails]

Avon - just on the way back home - there is one Antibiotic we can’t take on MTX - generally if you are unwell enough to stay in bed or are prescribed Antibiotics - Stop MTX - the only time this was different (for me) l was on long term Antibiotics & was not ‘ill’ ie High Temperature. I was on two 6month corses.

Hope you feel better soon 🙏🏼

[PMRCanada]

I had three rounds of antibiotics over the past year and each time I was instructed to hold my MTX until the abx were completed.

[Avon14 in reply to PMRCanada]

Thank you for sharing . Sounds like I have a plan now.

[Poshcards]

I am told by rheumy and GP to leave off metho until well past taking anti b's x

[NewtoGCA]

Hi. I take Pred & MTX and always stop MTX when I’ve had to take antibiotics. Reliably instructed by Rheumatologist, GP and Pharmacist to do so.

[Avon14]

Thanks you NewtoGCA, I have temporarily stopped MTX until the antibiotics are finished.