Azithromycin Therapy Question

[Antoine3323]

Hi there,

WARNING: Long post.

New guy here looking for some insight. I was recently clinically diagnosed with Lyme and other potential coinfections by two separate LLMDs. Unfortunately, still waiting on the Igenex tests results to come back, which hopefully, will confirm this to shed some more light on my case.

The first LLMD I saw put me on 100mg doxycycline twice daily along with other herbal supplements to combat the infections just about two weeks ago. Things seemed to be going well. I began having typical herx reactions with exacerbation of many of my most recent symptoms.

However, on the recommendation of a friend, I was told to go see a different LLMD. This physician strongly believes I have Lyme, Bartonella, and Babesia. To more aggressively tackle the Lyme and Bartonella, I was prescribed 500mg azithromycin daily to go along with my current regimen. I began taking it 3 days ago, and it appears as though I am experiencing a number of adverse side effects of the medication.

If someone here who has used azithromycin to battle Lyme and Bart could help comfort me in my decision to continue with the azithromycin therapy that would be great. Below are my concerns:

I am still confused as to whether or not I am experiencing adverse drug effects or a 'herx.' It is difficult to know because this disease has literally affected every tissue in my body. However, there are a couple things that make me suspicious of a drug allergy/adverse effect.

1. I have an immediate reaction to the drug. As soon as it touches my tongue, I begin to experience effects.

2. My reaction to azithromycin is completely different than my reaction to doxycycline. With doxycycline, the herx reaction appears to fall more in line with my recent symptomology; body temperature fluctuations, bulging veins, brain fog, weakness, and seizure-like activity to name a few. My reaction to azithromycin exhibits hardly any of these same characteristics.

Below is a chronology of signs/symptoms experienced following each dose of azithromycin. I took my third dose last night. Signs/symptoms seem to wax and wane throughout the day, but are most intense following a dose. I will say that I have experienced some of these symptoms over the past couple of months. However, some are completely new, or are presenting with greater intensity. I should also note that those symptoms that appeared first have lessened with each consecutive dose, while new symptoms seem to present with greater intensity. I have also listed below the published adverse side effects of the medication for comparison.

1st Dose:

Fast Responses:

    Tingling on tongue and lips
    Dry, cracked lips
    Conjuctivitis
    Nausea
    Dyspepsia
    Flatulence
    Dizziness
    Pruritis
    Mild throat angioedema

Delayed Responses:

    Rashes on back and neck
    Mild malaise
    Mild anxiety/agitation

2nd Dose:

Fast Responses:

    Decreased dry, cracked lips
    Decreased conjuctivitis
    Increased nausea
    Increased dyspepsia
    Flatulence
    Decreased dizziness
    Decreased pruritis
    Pharyngitis
    Taste perversion

Delayed Responses:

    Mild rashes on arms
    Intense malaise
    Mild fatigue/weakness
    Full body myalgias/arthalgias
    Intense headaches
    Increased anxiety/agitation
    Mild hearing disturbances/tinnitus
    Respiratory weakness
    Mild left/right upper quadrant pain and tenderness (Dull/Aching/Burning) (Gastritis/Cholecystitis?)
    Mild right upper quadrant rash
    Spotty urticaria appearing on skin over liver surface area
    Chest/rib pain
    Increased sensitivity to lorazepam

3rd Dose:

Fast Responses:

    Decreased dry, cracked lips
    Decreased conjuctivitis
    Nausea
    Dyspepsia
    Flatulence
    Decreased dizziness
    Decreased pruritis
    Decreased pharyngitis
    Increased taste perversion
    Feeling of skin crawling

Delayed Responses:

    Decreased malaise
    Increased fatigue/weakness
    Mild myalgias/arthalgias
    Mild headaches
    Increased anxiety/agitation
    Increased hearing disturbances/tinnitus
    Intense respiratory weakness (Feels like elephant is on chest)
    Increased left/right upper quadrant pain and tenderness (Dull/Aching/Burning) (Gastritis/Cholecystitis?)
    Increased right upper quadrant rash with obvious internal inflammation
    Increased chest/rib pain
    Increased sensitivity to lorazepam

-------------------------------------------------------------------------------------

Azithromycin Post-Marketing Experience:

Adverse events reported with azithromycin during the post-marketing period in adult and/or pediatric patients for which a causal relationship may not be established include:

Allergic: Arthralgia, edema, urticaria, difficulty breathing, and angioedema.

Cardiovascular: Arrhythmias including ventricular tachycardia and hypotension. There have been rare reports of QT prolongation and torsades de pointes.

Gastrointestinal: Anorexia, constipation, dyspepsia, flatulence, vomiting/diarrhea rarely resulting in dehydration, pseudomembranous colitis, pancreatitis, oral candidiasis, pyloric stenosis, and rare reports of tongue discoloration.

General: Asthenia, paresthesia, fatigue, malaise and anaphylaxis (rarely fatal).

Genitourinary: Interstitial nephritis and acute renal failure and vaginitis.

Hematopoietic: Thrombocytopenia.

Liver/Biliary: Abnormal liver function, hepatitis, cholestatic jaundice, hepatic necrosis, and hepatic failure have been reported, some of which have resulted in death.

Nervous System: Convulsions, dizziness/vertigo, headache, somnolence, hyperactivity, nervousness, agitation and syncope.

Psychiatric: Aggressive reaction and anxiety.

Skin/Appendages: Pruritus, rarely serious skin reactions including erythema multiforme, Stevens Johnson Syndrome and toxic epidermal necrolysis.

Special Senses: Hearing disturbances including hearing loss, deafness and/or tinnitus and reports of taste/smell perversion and/or loss.

[JackieCalifornia]

Others here are more conversant with these issues, but I understand that tests may well come back negative a long time after infection, because the immune system has largely stopped reacting.  Sometimes an antibiotic challenge is done, giving a short course of abx to wake up your immune reactions.  

That your doc uses IGeneX for testing is a good sign, but keep up with your own reading.  Sometimes even the best-intentioned docs go down stray paths.

If you are going to use various 'protocols', clear them with your doc first.  Herbs, supplements etc. may support a pharmaceutical approach, but they may also interfere with it.  Herbs = chemicals just as drugs = chemicals.

[Antoine3323]

I was tested for coinfections, as well. I got the new western regional panel done by iGenex. Everything came back negative for those, but I believe my physician is still going to try to treat for them. From my understanding, they can be even more difficult to detect than Lyme.

I'll definitely look into that James Wilson protocol. I'm willing to try just about anything to help in my recovery. I'm trying all sorts of detox remedies and supplements.

[JackieCalifornia]

Thank you!  You write wonderfully -- focussed and detailed, but very understandable for such technical/medical stuff.

I could see many of the symptoms in myself from back when I was so ill.

[youvegottobekidding]

NB you need to delete the spaces I inserted in the link above.

[youvegottobekidding]

Sorry to hear about the really bad ER episode, but I'm glad it wasn't a heart problem from the azith.

I had extremely bad adrenal insufficiency (to the extent I was investigated for Addisons disease) and I managed to resolve it by following a nutritional protocol in a book by James Wilson.
You just have to take nutritional supplements and give up a few foods (ones which are bad for us anyway).
It got rid of a very long list of symptoms for me (low BP, constantly waking in the night, endlessly urinating, headaches, exhaustion, lack of sex drive).
So, as you can tell, i'd stronly recommend trying this approach.

I summarised the protocol here
http://ihateticks. wordpress. com/2012/10/09/do-you-feel-tired-all-the-time/
But I'd recommend buying the book to get the full details.

Good luck with the new abx.
I havenì't had rocefin but my son had it and it worked extremely well for him.
When on that (especially IV) you have avoid getting too much calcium, do ask your docs for advice about that when the time comes.

[mojogal]

Congrats on getting the confirmation. Now it will be much easier for you. Your LLMD can test for co-infections.

I am on oral abx but was on IV Rocephin for a week in the hospital and I had no problems but I was already 10 months into my treatment.

Others may have more experience with it.