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High dose azithromycin

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Posted 8/4/2024 3:21 AM (GMT -5)
Hi anyone here on high dose azithromycin 1500-2000mg everyday? What is your weight? How do u feel on it
Posted 8/4/2024 5:54 AM (GMT -5)
that about double the recommended max dose regime for azithromycin - so would appear to be risky territory

liver enzyme issues are known to occur with azithromycin for some people at even regular doses

it also has a very long half life - many days - meaning if you did run into trouble it would take many days to get blood levels down again

given the risks - what would be the advantages over using a 2 or 3 drug combination therapy at more normal doses?
Posted 8/4/2024 5:19 PM (GMT -5)
My friend is on 2000mg daily azithromycin. I wonder if anyone been on this dose. Did it helped
Posted 8/4/2024 5:28 PM (GMT -5)
Azithromycin carries a black box warning for QTc prolongation and ventricular arrhythmias.

I also share Graze's sentiments.
Posted 8/5/2024 12:38 PM (GMT -5)
the reason i was asking about the rationale behind the high dose azithromycin approach is that from what we know about bacteria that form persister cells from the research into them - is, once they have formed persister cells in response to an antibiotic - more of that same antibiotic will have little or no impact on them.

essentially the persister cells are in a very low metabolic state - not using the metabolic pathway that the antibiotic targets - which is why they are unaffected by it.

in fact when it comes to typical bacteriostatic antibiotics like azithromycin - persister cells can tolerate anywhere between 500 and 1500 times the concentrations of normal cells.

as a result doubling the dose - even if it achieves double the concentrations in the body - will be unlikely to have additional useful effect on the persister cells

this is one of the main reasons that antibiotic combinations are used to treat chronic infections like Lyme, bart etc - as several drugs together can target more pathways - and studies show persister cells can be killed by antibiotic combinations that attack multiple pathways simultaneously - even used in biologically achievable concentrations, whereas single antibiotics cannot

so aside from the health risks of double dose azithromycin - its also less likely to be effective than suitable antibiotic combinations
Posted 8/5/2024 4:43 PM (GMT -5)
I would generally agree that high doses aren't useful.

I took 250-500 mg azithromycin to put the bacteria into a dormant persister state, then hit the persisters with something stronger.

The reason you don't want to start with the 'strong' stuff is that if you start killing the bacteria when they are in an active state, this will trigger a very bad inflammatory response much worse than a typical herx, which also risks triggering autoimmune disease. You want to put the bacteria into an inactive state first, so your immune system doesn't over-react.
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