Rifampin is almost always paired with another antibiotic in both human and veterinary medicine. The reason for this, is that many of the pathogens Rifampin targets (tuberculosis for example) have been shown to develop resistance very quickly. For Lyme specifically, bacterial resistance in the technical sense of the word has never actually been documented, but we all know that a lot of the science surrounding Lyme is questionable at times and there are always new exceptions that seem to be emerging all the time, and some researchers have hypothesized that resistance is potentially a reason behind Lyme treatment failures.
Using Rifampin for tick borne infections is considered off-label use, however it is very common and there are some good studies out there that show Rifampin is an effective treatment for ehrlichia as well as many strains of bartonella (which the CDC will tell you isnt tick borne at all, but thats for another post). There are also a lot of anecdotal reports on the internet of Lyme patients having a lot of success using Rifampin.
Not to confuse you, but monotherapy versus combination therapy can be a tricky subject. Some people have a lot of success keeping treatments simplified as possible and sticking to one medication, but over time as the disease progresses, most people treating Lyme who are going to LLMD's start using combination therapies because monotherapy has failed. Mono vs combo therapy can be even more tricky with Rifampin, because although, as I mentioned above, it is almost always used as a combination therapy, there are some concerns that Rifampin can speed up or slow down the metabolism of some other drugs, which may necessitate a change in dosage. So using a combo therapy with Rifampin, you have to be careful what you pair it with. There is a lot of research out there about
this subject. In fact if you do simple search of the word "Rifampin" on google, pulling up a drug facts page you will see that most times it used in combination therapy. It might be a good idea to print this off and take it in to your doctor and ask him what is his rationale for using it alone.
One thing I really hate about
these diseases is the "guessing game" a lot of doctors like to play. Dont get me wrong, there are a lot of good doctors who do clinical diagnosis and a lot of times success comes for people through following the steps of simple trial and error, but it also leaves a lot of room for lazy and un-knowledgeable practitioners to make convenient excuses for why you arent getting better. "Oh well you must have X coinfection which we havent treated yet and you havent tested positive for, lets try that" It's good to cover your bases, because tick diseases do travel in pairs and 3's and 4's, but I have seen a lot of people running on the hamster wheel with bad doctors who arent thorough. And it can be hard to tell if you are dealing with an experienced doctor who has good foundation for clinical diagnosis, or someone who is just winging it. This is why it's best to try to get as much of a clear answer as possible when it comes to coinfections. You want a positive test if you can get it, to prove infection to yourself and your doctor. Coinfection testing is just as difficult, or even more so than Lyme testing, but there are options if you can afford to pay for certainty.
There is a guy named Dr Breishwerdt who is a renowned veterinarian at NC State and is one of the top Bartonella researchers in the country. For what it's worth, he usually pairs Rifampin with Doxy, or Doxy with a floroquinolone to treat Bartonella.
His focus on Bart obviously began through diagnosing researching and treating Bart in dogs and cats. In his research he became frustrated that there werent very many accurate tests for Bartonela species available, so his team at NCST developed their own highly sensitive PCR testing technique for Bartonella. This PCR test has an absolute zero chance of a false positive. It uses 3 different blood draws.
He received so many inquiries to test people, that he actually started his own private sector diagnostic service called Galaxy Diagnostics that uses this refined testing technique. This is the best Bartonella test in the country, and if you have it, odds are they will find it. The downside is that it's VERY expensive. The full triple draw PCR coupled with standard Bartonella antibody tests is $970 and they dont bill insurance, (although you could possibly be reimbursed by your insurance company) If you can afford it, I would push your doctor to do this.
Whats great about
Galaxy, is that they actually have contracted with a company called "Any Lab Test Now" that has
locations all across the US. They will do any lab test without a doctor's order and provide the results directly to you. They take your blood and send it directly to Galaxy. You cant even do that with Igenix. You have to have doctor order it. So if your doctor refuses, and if you have the money (which is a big IF for most people) and really want to know if you have Bart you now have the option of doing it yourself.
Certainty is always best, if possible. But to answer your original question, there are a lot of different ways Rifampin is used by LLMD's. It can be effective for both Bart and Lyme in certain cases. Most times I have heard it being used as part of combination therapy, but it's not completely unheard of to use it alone. I would ask your doctor what his strategy is behind using it alone, and if you arent satisfied with his answer, maybe seek treatment elsewhere if that is an option for you.
On a side note, some reports say Rifampin should never be pulsed because there have been some reports of kidney problems if it is used intermittently. However some very experienced Lyme doctors have recommended pulsing it, and there are even people on this site that have pulsed it without any noticeable issues. Overall it seems pretty safe. Just watch your liver enzymes if you can, and dont be frightened if it tuns your sweat and urine red. This is very common and actually a good sign your body is absorbing the medication properly.
Like with most things Lyme related there is really no overall consensus. A lot of different methods are used, some unconventional. This is why it's important to have an experienced Lyme doctor whom you can trust who will answer all your questions. After all it is your treatment. Try to learn as much as you can. Research and ask a lot of questions. If this doctor cant or wont answer them, maybe move on if you have other choices. Keeping it simple isnt necessarily a bad approach, but at the same time I think you are right to question what the strategy is behind monotherapy when it seems most are using combination therapy for Lyme. Maybe he just wants to build you up to that slowly, so if you have a negative or positive reaction, you know what to attribute it to.
Post Edited (logmoss82) : 5/2/2018 4:04:39 AM (GMT-6)