Starting Antibiotics--Need Help

I was on similar protocols.

I took my ABX at 6am and 6pm, and my probiotics and Magnesium at 11am and just before bedtime.
This give the probiotics all night to settle in before next round of abx wipes them out.

I always took nystatin along with abx.

I had a cast iron stomach and never had breakfast with Abx. I mostly took pm abx just before diner unless we ate out earlier on a weekend. When on Mepron I did take some peanut butter to aid absorption.

Start slow with Zith alone is smart. Since you have had past issues give it a week before going to Rif, But start Rif at 1/2 dose for one week, then move up to full dose for a few days, then at Plaq. Plaq is pretty benign and doesn't react much with anything.

In case of an allergic reaction call your LLMD immediately and stop whatever you added last.

Some LLMDs pulse... and some don't. I find it more common that pulsing is done closer to the end of treatment rather than at the start. But some LLMDs start pulsing right away. There is no single answer, if there was we all would be better by now.

just my 2cents based on years of practice.

MA10 said...
I should be starting antibiotics by this weekend or first of next week. But, my doctor gave me NO direction. He wrote a script for azithromycin, rifampin, and plaquenil and said, "I fully expect you're going to herx." That was it. So I have a ton of questions. I was hoping maybe you could help.

1) How close or far away do you take from food?
2) How close or far away from other meds and probiotics? (thyroid meds, psych meds, adrenal meds)
3) Do I take the Nystatin with the antibiotics?
4) Do I take it with breakfast and dinner, or can I take it with lunch and dinner?
5) How long do I need to take one antibiotic before introducing the next one? Two weeks? Three weeks?
6) What do I do in the case of an allergic reaction? (I've had an allergic reaction to zmax before.)
7) Are you supposed to pulse these?

I'm starting the Zmax first just to watch for allergic reactions. I do know that much. But I'm pretty clueless on the rest.

Thanks for your help! We'll discuss detox in another post.

When I'm on Rifampin, I take it first (best on empty stomach). I would wait about 1/2 hour and add my other antibiotics and then eat. (A full hour is ideal with Rifampin though)
I take my abx in the morning when I get up and then before dinner.
Taking the abx with lunch and dinner is too close together. 12 hours is ideal...but for me it's more like 9 hours apart.

I would start with Azithromycin and give it a week before adding in the Rifampin. That way if you have an allergic response, you know it's from the zithro.
Rifampin can hit hard...so it's a good idea to start with half dose. (I actually took 1/4 dose for several days - I opened up the 300 mg capsule and split it)
Is your Rifampin dosage 300 mg twice daily? I would do 300 daily for a couple of weeks (at least one week)

Why are you taking Azithromycin if you're allergic to it? Why not do another macrolide - like Biaxin?

If your Dr. wants you to pulse, he would have told you to.

Some LLMD's prescribe pulsed method...but most still believe in daily dosing.
I find the pulsed method much easier to tolerate.

Probiotics: I take mine twice daily. I take them 2 hours or longer after antibiotics. For me that's usually mid-day (with lunch) and a couple hours after dinner.

Girlie, that was my question exactly. Why are we trying something that I am probably allergic to. SMH. I don't know where his head was that day. So helpful.

Right, Pirouette! The best part is that when I do have an allergic reaction, or start herxing and don't know what to do, it will literally take them AT LEAST 7 days to respond to me. It even says on their voicemail, pleas allow 7 business days for all inquiries and requests. What the heck?!

Thanks for the answers, everyone!

1) How close or far away do you take from food?
2) How close or far away from other meds and probiotics? (thyroid meds, psych meds, adrenal meds)
3) Do I take the Nystatin with the antibiotics?
4) Do I take it with breakfast and dinner, or can I take it with lunch and dinner?
5) How long do I need to take one antibiotic before introducing the next one? Two weeks? Three weeks?
6) What do I do in the case of an allergic reaction? (I've had an allergic reaction to zmax before.)
7) Are you supposed to pulse these?


1) rif does not need to be taken with food. although you can start the rif dosage with food to decrease the strength, then work up to taking it away from food. I took plaq with food, I haven't tried amax.

2). I try to prob before abx. I take the Prob no closer than 1.5, ideally 3 hours before abx. If taken after food you should wait 3 hrs after eating. if you''re taking abx at breakfast and din Prob at night is good if possible to get it in deep to your gut, and one mid afternoon works .

Any other meds you may be taking may have reactions to your lyme drugs, you need to confirm this.

3). I did.

4) Totally up to you, it really depends on your overall plan to schedule with others such as charcoal/ binders, detox, supplements etc. Morn and eve does spread it out nicely and may prevent a major herx rather than taking them closer together.

5). My llmd tells me to make sure i take rifampin within 24 hours of another abx or else resistance will occur to the rif. also tells me if i stop rif for long period the rif will no longer work (period not specified but does have me pulsing off the rif for 3 days). something to consider / keep in mind.

6). If major reaction then stop drug - try charcoal/ binder to flush it out and go to ER if throat tightens or symptoms are really bad.. did you mention your known allergies to your doc?

7) in the past I'v pulsed when on plaq , and I'm currently pulsing with the rif.

Good luck and detox...

Post Edited (Kirky98) : 5/18/2017 10:04:19 AM (GMT-6)

MA10 said...
bluelyme, yes, we're going after Bartonella first. Thanks for the happy herxing. ;) I am taking milk thistle for liver. Taking a cortisol manager for adrenals. Do you think that would be enough? That and the obvious other detoxing methods.

Kirky98, THANKS! I'm confused about the rifampin. Does that mean that if you skip a rifampin dose, then you have to take it the next day? I'm not really sure what you meant with that. Sorry. Lyme brain. I did mention my allergy to my doctor. He offered to prescribe me an epipen. haha. How considerate. "here, I know you're allergic, and this may kill you, so instead of not prescribing the zithro, I'll just give you an epipen." ?? Really.

I'm told by llmd:

- you can pulse rif for a short period of time (ok to go off for short period of time) but can not go off for long period then back on. You can form a reaction to rif if you go off and then back on with long gap.

- When you take rif you need to also take with another ABX. When taking rif make sure you have another abx in your system within 24 hours or resistance can form.

Post Edited (Kirky98) : 5/18/2017 10:19:42 AM (GMT-6)