Azithromycin - 2*250 mg or 1*500 mg a day?

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Jamtland
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Date Joined Dec 2017
Total Posts : 12
   Posted 4/9/2018 4:20 AM (GMT -6)   
Hello!

Me and my doctor are not completely sure what is best, to take Azithromycin twice daily (2*250 mg) or once daily (1*500 mg). I'm taking it together with Minocycline and Bactrim currently for Borrelia and Bartonella. 2*250 mg gives a more even level in the blood (blood half life is short) and is perhaps better for preventing resistance, but 1*500 mg perhaps goes better to the brain.

Which dosage do you use? What would you recommend? Do you know of other doctors opinions on this?

Thank you in advance!

/J

Girlie
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Date Joined May 2014
Total Posts : 32685
   Posted 4/9/2018 11:20 AM (GMT -6)   
"(blood half life is short)"


No, Azithromycin has one of the longest half-lives of the antibiotics that we take for lyme and co's.

something like 68 hours...so it builds in your system.


I would go with the 500 mg once daily..

Some Docs prescribe 500 mg twice daily.
Moderator, Lyme Forum
Symp started April/2013; Buhner's Lyme May 15-July24/14; Igenex pos. July 3/14
Doxy: July 4-Aug.24/14;Zithro July26-Aug24/14; Amox + Proben. Aug. 29/14;
added biaxin Sept. 26/14
Disc. amox,added Ceftin Nov. 20th.;
Disc. biaxin added Buhner bart herbs Dec/14;Jan/15 pulsing Tinda (w/ Ceftin);
Abx/herb break Apr-July/15; July-mino; Aug. added Rif;
Nov./15 mino - to biaxi

Jamtland
New Member


Date Joined Dec 2017
Total Posts : 12
   Posted 4/9/2018 12:02 PM (GMT -6)   
Thank you for the quick reply.

Unfortunately the long half life is only for the tissues. The azithromycin moves quickly to tissues and concentrates there, and the half life in blood is therefore much smaller, around 4 hours in the following study:

http://aac.asm.org/content/57/4/1736/F1.expansion.html

Anyone else with input? smile

Girlie
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Date Joined May 2014
Total Posts : 32685
   Posted 4/9/2018 12:55 PM (GMT -6)   
Take a look at this: I didn’t have time to read through it all yet

aac.asm.org/content/57/4/1736.full

Edit - it’s the same link you posted .

"Both during and after the end of active treatment, azithromycin concentrations in plasma were markedly higher than in muscle and subcutis. Only on day 10 did drug levels seem to equilibrate between soft tissues and plasma. Azithromycin concentrations were quite comparable within both soft tissues at all time points."
Moderator, Lyme Forum
Symp started April/2013; Buhner's Lyme May 15-July24/14; Igenex pos. July 3/14
Doxy: July 4-Aug.24/14;Zithro July26-Aug24/14; Amox + Proben. Aug. 29/14;
added biaxin Sept. 26/14
Disc. amox,added Ceftin Nov. 20th.;
Disc. biaxin added Buhner bart herbs Dec/14;Jan/15 pulsing Tinda (w/ Ceftin);
Abx/herb break Apr-July/15; July-mino; Aug. added Rif;
Nov./15 mino - to biaxi

Post Edited (Girlie) : 4/9/2018 3:44:29 PM (GMT-6)


mpost
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Date Joined Feb 2015
Total Posts : 1522
   Posted 4/9/2018 3:02 PM (GMT -6)   
tissue half life is what you need with lyme. disseminated lyme is a tissue disease, lyme likes to stay in tissues not in blood.

so yeah, azithromycin is good because it has huge tissue half life

on its own azithromycin is a weak antibiotic. it is used to boost antibiotic effectiveness in combinations. also it is used to prevent bartonella from becoming resistant to monotherapy. for eg bartonella quickly becomes resistant to rifampin alone. you should NEVER use one antibiotic to treat chromic lyme, that is a really bad idea, for many reaons. coinfection antibiotic resitance, lack of effectiveness to mention two.

mpost
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Date Joined Feb 2015
Total Posts : 1522
   Posted 4/9/2018 3:04 PM (GMT -6)   
i take azitrhomycin 1x500 on monday, wednesday and friday. so 3 days a week 500mg.

Jamtland
New Member


Date Joined Dec 2017
Total Posts : 12
   Posted 4/11/2018 3:22 PM (GMT -6)   
Thank you mpost!

I use it for Bartonella together with Bactrim and Minocycline. Soon we will replace Bactrim with Rifampicin.

My question is, for Bartonella protocolls, the most annoying bug from resistance point of view, is it more common to take 250 mg twice a day or 500 mg once a day?

Jamtland
New Member


Date Joined Dec 2017
Total Posts : 12
   Posted 4/11/2018 3:43 PM (GMT -6)   
Also, on http://www.treatlyme.net/treat-lyme-book/kills-bartonella-a-brief-guide/ it is mentioned for bartonella:

Rifampicin + "azithromycin (Zithromax) 500mg 1 pill time a day"

Does anyone know if this is a typo? Does he mean 1 pill 2 times a day or 1 pill 1 time a day?

sierraDon
Regular Member


Date Joined Aug 2016
Total Posts : 184
   Posted 4/12/2018 9:06 AM (GMT -6)   
I am curious about this too, anyone else have any feedback on any real difference between 1x500 or 2x250. most of the dosages noted online for zithro are one 500mg PO

anyone doing zithro 2x250?

thanks

Jamtland
New Member


Date Joined Dec 2017
Total Posts : 12
   Posted 5/5/2018 2:43 PM (GMT -6)   
Bump

Anyone else like to share their knowledge on this? Dr. Marty Ross has clarified now on his page that he uses 500 mg once a day, but in Dr. Horowitz book both alternatives are mentioned.

Girlie
Forum Moderator


Date Joined May 2014
Total Posts : 32685
   Posted 5/5/2018 2:59 PM (GMT -6)   
I'm still thinking about the half-life - as from what I've read - it is blood levels...not tissue.


https://www.verywellmind.com/medication-half-life-380031

A medication's biological or terminal half-life is how long it takes for half of the dose to be eliminated from the bloodstream.


https://www.nottingham.ac.uk/nmp/sonet/rlos/bioproc/halflife/index.html

"We usually consider the half life of a drug in relation to the amount of the drug in plasma. A drug's plasma half-life depends on how quickly the drug is eliminated from the plasma. "


https://www.news-medical.net/health/What-is-the-Half-Life-of-a-Drug.aspx[url]

"The elimination half-life of a drug is a pharmacokinetic parameter that is defined as the time it takes for the concentration of the drug in the plasma or the total amount in the body to be reduced by 50%. "

Dr J prescribes it as 500 mg doses (can't remember though if that's once or twice daily - I would think twice daily as he doesn't skimp on antibiotics...)
Moderator, Lyme Forum
Symp started April/2013; Buhner's Lyme May 15-July24/14; Igenex pos. July 3/14
Doxy: July 4-Aug.24/14;Zithro July26-Aug24/14; Amox + Proben. Aug. 29/14;
added biaxin Sept. 26/14
Disc. amox,added Ceftin Nov. 20th.;
Disc. biaxin added Buhner bart herbs Dec/14;Jan/15 pulsing Tinda (w/ Ceftin);
Abx/herb break Apr-July/15; July-mino; Aug. added Rif;
Nov./15 mino - to biaxi

Post Edited (Girlie) : 5/5/2018 3:08:33 PM (GMT-6)


Dahlias
Regular Member


Date Joined Jun 2017
Total Posts : 465
   Posted 5/6/2018 1:59 AM (GMT -6)   
Girlie said...
Dr J prescribes it as 500 mg doses (can't remember though if that's once or twice daily - I would think twice daily as he doesn't skimp on antibiotics...)


They prescribed it as 500 mg twice daily for me.

I reacted to it last time I took it and called my PCP's office for advice. They were surprised at the dosage.
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