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Reti

Need a new antibiotic to switch to...

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Erythromycin just went up 1475% the last few months and I can no longer afford it. I need something else. I have some ideas what I might ask for from the doc, but I want some outside recommendations. If you have a rec, it's probably better to state why you or your docter preferred it versus another one. That might be more helpful than just saying what's worked for you irrespective of an alternative. But I guess beggers can't be choosers... Oh, and I would plan to be on this long-term, so realize this can't be a drug that's not indicated for longterm use. The only antibiotics I've ever been on are Amoxicillin, Penicillin, and Erythromycin. First two as a kid. Third obviously for the acne. Here's what I can choose from: (by the way, forget the dosing quantity pricings on the right... I just copy and pasted)

Amoxicillin 125mg/5ml susp (80ml bottle)† . . . . 1 . . . . . 3

Amoxicillin 125mg/5ml susp (100ml bottle)† . . . . 1 . . . . . 3

Amoxicillin 125mg/5ml susp (150ml bottle)† . . . . 1 . . . . . 3

Amoxicillin 200mg/5ml susp (50ml bottle)† . . . . . 1 . . . . . . 3

Amoxicillin 200mg/5ml susp* (75ml bottle)† . . . . 1 . . . . . . 3

Amoxicillin 200mg/5ml susp* (100ml bottle)† . . . . 1 . . . . . 3

Amoxicillin 250mg/5ml susp (80ml bottle)† . . . . . 1 . . . . . . 3

Amoxicillin 250mg/5ml susp (100ml bottle)† . . . . 1 . . . . . 3

Amoxicillin 250mg/5ml susp (150ml bottle)† . . . . 1 . . . . . . 3

Amoxicillin 400mg/5ml susp (50ml bottle)† . . . . . 1 . . . . . 3

Amoxicillin 400mg/5ml susp* (75ml bottle)† . . . . 1 . . . . . . 3

Amoxicillin 400mg/5ml susp* (100ml bottle)† . . . . 1 . . . . . . 3

Amoxicillin 250mg cap . . . . . . . . . . . 30 . . . . . .90

Amoxicillin 500mg cap . . . . . . . . . . . . . 30 . . . . .90

Cephalexin 250mg cap . . . . . . . . . . . 28 . . . . .84

Cephalexin 500mg cap . . . . . . . . . . . . . 30 . . . . .90

Ciprofloxacin 250mg tab . . . . . . . . . . 14 . . . . . .42

Ciprofloxacin 500mg tab . . . . . . . . . . . . . 20 . . . . .60

Doxycycline Hyclate 50mg cap . . . . . . . . 30 . . . . .90

Doxycycline Hyclate 100mg cap . . . . . . . . . . 20 . . . . . .60

Doxycycline Hyclate 100mg tab . . . . . . . . 20 . . . . .60

Penicillin VK 250mg tab . . . . . . . . . . . 28 . . . . . .84

Penicillin VK 125mg/5ml susp (100ml bottle)† . . . . 1 . . . . . . 3

Penicillin VK 125mg/5ml susp (200ml bottle)† . . . 1 . . . . . 3

Penicillin VK 250mg/5ml susp (100ml bottle)† . . . . 1 . . . . . . 3

SMZ-TMP 200mg-40mg/5ml susp*. . . . . . . 120ml . . . 360ml

SMZ-TMP 400mg-80mg tab . . . . . . . . . . . . . 28 . . . . . .84

SMZ-TMP DS 800mg-160mg tab . . . . . . . . 20 . . . . . .60

Tetracycline 250mg cap . . . . . . . . . . . 60 . . . . 180

Tetracycline 500mg cap . . . . . . . . . . . . . . . 60 . . . . . 180

Edited by Reti

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And anyone know which of these are not at all considered ototoxic? I'd like to get back to listening to loud music and djing one of these days. Maybe that could narrow it down a little.

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None of them appear to be highly ototoxic. Erythromycin is considered slightly at very high doses, but not at what I was at. I still got some ringing from it and dulling, but it goes away if I stay away from loud sound or stopped taking it. Amongst the 'cyclines, only minocycline is considered as equivalent a risk to erythromycin, with the others being considered an even more rare side effect.

SMZ-TMP has a high incident of allergic reactions and requires a lot of fluids to stay hydrated. Other than that, it seems to work very effectively in some patients for acne and they have used it for an extended time.

Cephalexin appears to be contra-indicated for long-term use.

Doxycycline has the highest problems with sun sensitivity, but all the 'cyclines do it a bit.

Ciprofloxacin doesn't seem used much for acne, but is the safest, along with the 'cillins, for people with sensitive ears. There's a history of spontaneous tendon ruptures. I work out and jog, and had some issues with ligaments and tendons when super-dosing on Vitamin A for a long time. I’ve had a couple corticosteroid injections for poison oak and acne inflammation at different times, which apparently makes the risks even bigger. So that's probably eliminated for multiple reasons.

Apparently the thing about tetracycline and un-bleachable gray teeth is only in children. Once your adult teeth are all in, it should be a minimal issue. Tetracycline is not only safe for long-term use in people who have no sensitivities to it, but it’s often recommended to be used for at least a year or two. It is supposedly similar to erythromycin in its anti-inflammatory properties, though it does not affect sebum absorption and spreading around on the skin the same way. It can also be used at the same time as erythromycin and has a synergistic effect, according to a 1987 study. I have one more bottle left of the ery eccaps, so I could overlap them. If the ery price ever comes back down, I might get it added back if I go to tetracycline.

I’m very worried about tetracycline’s reduction of the immune system and increase susceptibility to organ and soft-tissue damage from a car accident or someone hits you with a baseball bat while on it. Technically working out is a form of injury on the body, which then gets stronger. It’s one of the class of antibiotics often cited for its systemic side-effects when people like Dr. Oz say not to take antibiotics unless you absolutely have to. WTF? A local pharmacist tells me that’s exaggerated and not to worry about it. Those effects are lab data and not enough to be worried about in normal life. Still spooky, because erythromycin practically spoils me with how well I tolerate it… other than nausea and diarrhea if I don’t take it with food. I also can't find a single post on acne.org of someone who's been on it indefinitely and they still have a better response to it than off it, as I have experienced with ery. Tetra seems to stop working eventually with everyone who goes on it.

Or maybe the people it cures just never show up on the board again? heh heh. That's a nice thought.

Anyone still on tetracycline after long periods and still find it effective?

Anyone on this board EVER had your teeth become irreversably gray from tetracycline? I assume there are no children on the board.

Edited by Reti

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I need something else. I have some ideas what I might ask for from the doc, but I want some outside recommendations. If you have a rec, it's probably better to state why you or your docter preferred it versus another one. That might be more helpful than just saying what's worked for you irrespective of an alternative. But I guess beggers can't be choosers... Oh, and I would plan to be on this long-term, so realize this can't be a drug that's not indicated for longterm use. The only antibiotics I've ever been on are Amoxicillin, Penicillin, and Erythromycin. First two as a kid. Third obviously for the acne. Here's what I can choose from: (by the way, forget the dosing quantity pricings on the right... I just copy and pasted)

Bactrim(SMZ-TMP) will cause an allergic reaction in about 20% of people(myself included), but per my Derm is pretty much the strongest oral antibiotic option for acne. Doxycycline is probably your best economy antibiotic option(very commonly used for acne). Then Tetracycline, but I don't get the impression there is much of a reason on would pick it over Doxycycline.

All the teeth staining issues are only really an issue when they are still developing. So you'd have to be pretty young for it to be an issue.

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If it's on the list, cost is not an issue. Erythromycin was actually the most expensive on it when I was buying it but still reasonable.

One in five for reactions is not settling my mind on the sulfa antibiotics. Hmmm... Might be worth a try before switching to the 'cyclines, though. It is considered more ototoxic, but if I don't get an issue on it and avoid noise, maybe it's worth a try.

I hear something about the patients on Bactrim(SMZ-TMP) needing blood tests to check for white blood cell counts. Have you heard that?

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Sheeeiiiit. My doc was going to put me on minocycline, but then I commented it would probably be too expensive for me and requested he do generic Bactrim, Doxycycline, or Tetracycline.

uhmmmmmm....

He put me on 250mg of Tetracycline ONCE A DAY. Is this stuff three times as strong as Erythromycin? Because I've been on 750mg of that a day for a long time and any less isn't enough. And I thought Tetra only stays in your system 6-12hrs. Isn't this just going to be a sugar pill that low? The pharmacist, looking at the slip, commented it's the lowest possible dosing and asked if I'd already been on it at a higher dose... not to mention 90 caps of 250mg for 90 days is the same price as 180 caps of 500mg for 90 days. Ten US dollars either way, even though it's a 4X difference in amount of meds.

You know, I wonder if I should have waited a week and stopped using ALL topicals and the Erythromycin before going in for a visit. Last week I accidentally did up a bottle of Salicylic Acid that was probably closer to 10-20% potency. I knowingly put an extra scoop in and instead of using isopropyl alcohol used ethyl alcohol which turned out (unknown to me) to be denatured with significant amounts of acetone and ketone. Ethanol, acetone, and ketone are the best solvents for Sal Acid there are. WAY more so than isopropanol. It turned my lips white within seconds and I had to jump in the shower. So my face just got done peeling and looks as good as it has in months, aside from a lot of red flush spots (superficial scaring) on my forehead and temples and one moderate cyst on my left temple.

Maybe I screwed myself over for this visit. I told them I've been putting a massive amount of stuff on my face lately to get it looking this good IN ADDITION to the Erythromycin three times a day prescription.

Here's what I've been doing:

Chlorhexidine Gluconate or PCMX (far preferred for safety reasons) wash.

The homemade Sal acid toner, which is usually 2-3% in 50-75% isopropyl alcohol.

BPO 10% lotion/gel.

Occasionally 10% sulfur... but that's really harsh with the others.

Then either Acne.org moisturizer, mineral oil, jojoba oil, or petroleum jelly... depending on how my skin feels and the occasion.

Then on really inflamed days, I substitute maximum strength triple antibiotic ointment in a petroleum jelly base for all the topicals after the wash until my skin can handle them again.

I have a very strong suspicion I won't be able to do less of this topical regiment on low-dose tetracycline, as I was hoping. It's such a pain in the ass putting all that stuff on and maintaining an inventory. I just want to pop pills according to a schedule, you know?

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That still doesn't change the fact I could barely afford minocycline and 250mg/day of tetracycline is inadequate and even doxycycline is better. I can't find any site or research that says one dosing of 250mg is correct, even if the total dose a day is that much. It's supposed to be split up into 2 or 4 doses. So 125mg twice a day would be how you'd normally do the smallest maintenance dose of 250mg/day. Next would be 250mg twice a day. Then either 250mg four times a day or 500mg twice a day. Either of these last two would have been fine, as it's right in the middle of recommended treatments. Higher doses are not usually appropriate for more than a month or two and are for acute bacterial infections. I didn't expect that. So the dosing is sloppy and the drug is the worst of the three. JOY!

Minocycline 100 mg daily for 1 month

Doxycycline 100mg bid for 1 month

Tetracycline 1gm daily for 1 month

These are considered basically equivalent treatments, even though they get inferior the lower you go down the list due to absorption, distribution to the pores, and bacterial resistance. Maybe he picked tetra over doxy due to summer coming up, but that still doesn't explain the odd dosing... except for him thinking I really didn't need much due to, frankly, an exceptional couple of days of skin that I just happened to need a new script during.

Oh well. If my face gets worse in 90 days, I can always prod him to bump it up in dosage or move over to minocycline if I find a generic of that I can afford. At least I know he has interest in prescribing it and that taking tetra instead for a while won't reduce it's effectiveness later. So that article is useful. Thanks.

Edited by Reti

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