Length of Time on Antibiotic Regimen

Posted by lorrie48 @lorrie48, 6 days ago

I was wondering how long the people here have been or had been taking the Triple Cocktail. I'm also curious about the dosages you've been prescribed. I started with 1 azithromycin, 1 ethambutol, and 2 rifampin 3x/wk. Four months in, my pulmonologist prescribed 1-3-2 3x/wk. I expect the dosages to be increased again, since the coughing has increased, not decreased, since I started the meds six months ago. I'd really appreciate hearing about the success of others' treatments.

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@dulwich

The guidelines say that treatment should be continued for one year of negative cultures
There is some evidence that treatment for 18 months reduces the risk of relapse and that is what I did. No Mac for three years and off treatment two years next April.
Doing well but much more sputum in last two years and now colonized with Staph aureus. I do sometimes wonder about whether this is just the progression of bronchiectasis or worsened by 4 years of antibiotics including 20 months of Arikayce

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I, too, wonder about the ill effects of being on so many antibiotics for such a long period of time. Given the comments on this page, I'm beginning to think the year of treatment that my pulmonologist initially mentioned is actually a lowball estimate. It's disheartening, especially since I'm someone who used to enjoy having to take almost no meds her whole life. But dealing with real answers, however disheartening, has felt better than dealing with false hopes.

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@sueinmn

Kristi - I am totally confused! Are you being treated for non-tubercular mycobacteria (referred to as NTM, MAI or MAC), pseudomonas, or something else? Were you diagnosed using a sputum culture or a bronchoscopy?
The current bacterial infection loads for NTM and pseudomonas are determined by sputum cultures, which take 2 weeks for pseudomonas and 6-8 weeks for NTM to grow sufficiently to be fully identified. I am unfamiliar with any blood tests for this purpose.
Maybe they are checking to be sure your kidneys and liver are functioning properly, as these medications can affect them.

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I have Non-tubercular mycobacteria and Bronchiectasis. I am taking the 3 antibiotics for the MAC. I was diagnosed after a bronchial wash. It took 6 weeks for the culture to grow. He is treating the Bronchiectasis because I have a secondary infection from a cold. I don't know if it is even the Bronchiectasis causing me problems. I know I have an infection because I am running a 101 fever. I have no symptoms from MAC. I am worried now, though. I just finished a week-long antibiotic to treat the secondary infection, and I am no better. I am waiting for the doctor to get back to me with the next step. I am starting to feel like this will not get any better. Even with my severe asthma, I never had more than 4 days of breathing issues. I'm going on 4 weeks now. I know what happens when it can't be improved, and I am not ready.

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I'm going on 7 years of the Big 3, 6 years of inhaled Arikayce and 2 years of Clofazamine.

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@ldylouis

I have Non-tubercular mycobacteria and Bronchiectasis. I am taking the 3 antibiotics for the MAC. I was diagnosed after a bronchial wash. It took 6 weeks for the culture to grow. He is treating the Bronchiectasis because I have a secondary infection from a cold. I don't know if it is even the Bronchiectasis causing me problems. I know I have an infection because I am running a 101 fever. I have no symptoms from MAC. I am worried now, though. I just finished a week-long antibiotic to treat the secondary infection, and I am no better. I am waiting for the doctor to get back to me with the next step. I am starting to feel like this will not get any better. Even with my severe asthma, I never had more than 4 days of breathing issues. I'm going on 4 weeks now. I know what happens when it can't be improved, and I am not ready.

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With fever of 101, I’d encourage you to be persistent in contacting your doc. Are you doing airway clearance?
I’m so sorry you’re having a hard time.

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Hi Lorrie, I started the three time/week regimen (azithromycin, ethambutol, rifampin) for MAC in Feb 2023 and with no success, moved to the daily regimen around August 2023. A number of months later (still with no success) we added clofazimine. In August 2024, I started Arikayce daily. I lost my voice completely by day 7, stopped the meds for 2 weeks until it came back, then started the 3x/week Arikayce protocol. After just a month of treatment, I had my first MAC negative culture. So don't give up hope.

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@carolj68

Hi Lorrie, I started the three time/week regimen (azithromycin, ethambutol, rifampin) for MAC in Feb 2023 and with no success, moved to the daily regimen around August 2023. A number of months later (still with no success) we added clofazimine. In August 2024, I started Arikayce daily. I lost my voice completely by day 7, stopped the meds for 2 weeks until it came back, then started the 3x/week Arikayce protocol. After just a month of treatment, I had my first MAC negative culture. So don't give up hope.

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I know your excited about your negative culture, and I'm very encouraged by it. Two questions: Have you been taking the Arykace along with your med regimen, and will you have to be on the Arykace for a year?

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Hi Lorrie, I was on 4 antibiotics - azithromycin, ethambutol, rifampin and clofazimine and didn't clear, at which point I added the Arikayce, which was the fifth. The protocol is to continue on all the meds you are on for a year at the point when you clear MAC, but I actually had to stop ethambutol a month ago (I had an visual evoked potential test which showed ocular nerve neuritis resulting from the ethambutol; this fortunately preceded any measurable changes in my vision and will hopefully resolve with time). So this week I am getting 3 AFB cultures and hopefully they will be negative without the ethambutol. If so, I will stay on the 4 antibiotics for a year and then be done with treatment.

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