Connect
← Return to Did your MAC symptoms improve once you started Big3?
Discussion
Did your MAC symptoms improve once you started Big3?
MAC & Bronchiectasis | Last Active: Jul 6 2:25pm | Replies (90)Comment receiving replies
Hello, I’m new to the forum as I was recently diagnosed with a MAC infection and just started the big 3 last Friday. I’m take one ethambutol, one Rifabutin and 4 azithromycin three times a week, MWF. I’m taking a probiotic each day to help avoid stomach upset and that has worked fairly well. I have a little nausea today and a headache. I’m still trying to figure out how to space the antibiotics and probiotics that work best for me. My issue is the day after taking the Rifabutin, I start running a fever and getting chills later in the afternoon. I feel terrible until taking a low dose of ibuprofen or acetaminophen and waiting for that to give me some relief which takes a while. Anyone else have this side effect and does it get better or do I need to get off that medication? This is my third day after taking the medication that I feel terrible the next day. Any advice or information would be greatly appreciated. Thank you.
Replies to "Hello, I’m new to the forum as I was recently diagnosed with a MAC infection and..."
Hi there
Are you taking 4 Azithromycin? I have not heard of that dosing before. I understood it was 4x ethambutol, 1x Azithromycin and 2 x rifampicin. I thought I’d ask as 4 Azithromycin sounds an awful lot???
Hi Laura. I started the Big 3 three times a week in February, had a rocky couple of months, but am feeling much better now and coughing so much less. I take 500 mg Azithromycin and 1500 mg Ethambutol with breakfast and 600 mg Rifampin on an empty stomach (although with a full glass of water) before bed, a dosing schedule I learned on this site. And every single day I eat a 5.3 ounce container of Greek yogurt, which has kept my digestive system comfortable.
Those first couple of months, while your body is adjusting, can be tough. I too experienced some nausea and loss of appetite from the Azithromycin and Ethambutol and often felt crummy the day after taking the Rifampin. My pulmonologist said it was okay to take ibuprofen for the fever and discomfort.
My heart goes out to those taking these drugs seven days a week; that must be so much more difficult.
I hope you are able to give your body time to adjust to these powerful drugs. They are effective precisely because they are so powerful! Do you have monthly sputum testing done? My April samples just came back negative for AFB, which makes me glad I persisted through those first months of discomfort and feeling sick. Wishing you strength!
@lauraws . I had the low grade fevers when I was diagnosed BEFORE I started the meds, But I found that my low grade fevers went away after being on the meds for a few weeks. Make sure your doc knows about the fevers/chills. You will find a schedule that works for you. I have been on Big 3 for a year. I take my Rifampin at 3:30 p after no food except water for 2 hours. That way I get a good breakfast & lunch done. I take the Ethambutol & Azithromycin after I eat dinner at 5 pm. I also take *2 gas X tabs with the Ethambutol & azithro, it seems to help my bloating & cramps on days I take the big 3. I am also on arikayce inhaled since March 2025. I take my other routine meds at 10 am & again at 8 pm. Do what works best for you & hang in there !
Connect
I haven't been treated for MAC, but want to bump up your question. Also, there was a recent thread that evolved into some discussion of med timing you might find helpful.
https://connect.mayoclinic.org/discussion/penn-medicinerifampin/