IV VANCOMYCIN- I have questions PLEASE

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
Fin24
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IV VANCOMYCIN- I have questions PLEASE

Post by Fin24 » Thu 12 Mar 2009 22:21

we are about to place Evan on IV Vanco 1 gm bid
and we have conflicting info re necessity of having a micron filter on the admin tubing-makes it almost double the price for tubing to $7.50 a pce or 157.50 a week on tubes alone ( the math = $630. per month--more than some pay for rent!!)

ALL thoughts guesses and advice needed!!
we plan new tubes every admin and not re-use of tubes as one infusion company suggested ( "after all you have the bacterial filter so why not re-use"--I told them we have the picc 6 months with little problems due to our vigilant care thank you and will continue safely)

the vanco pkg inserts do NOT say anything--only that it must be admin 60 or more minutes in at least 200 ml of IV fluid ( dextrose or saline) which we knew

and yes Im aware of all the risks and effects possible ( kidney, deafness,etc)

and that it wont cross BBB easily if at all and is dismally futile against rickettssials and myco's

we are also piggybacking in 2 days IV Zithro ( 500 mg per day) and then in another few days adding to the stew oral Rifampin due to his heavy Bart sx and pos tests

so the protocol will end up as IV Vanco+ IV zithro + oral Rif

Im considering having the Dr add some antiviral at some time too

we are at the point of needin to slam this crap hard

thanks for your feedback

( fyi the plain gravity tubes are a case of 50 for $109.00 or about 2 dollars so a BIG difference)

cave76
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Re: IV VANCOMYCIN- I have questions PLEASE

Post by cave76 » Fri 13 Mar 2009 14:49

Haven't an answer yet, sorry. And I assume you've read google hits thoroughly.'

So, a micron filter goes down to .2 microns (states filters out all bacteria)

And a gravity filter doesn't-----

That part seems simple. But IS there apt to be bacterial contamination in the infusion? And I know that when your son infuses at home and NOT in a germy hospital setting) would that be needed?

I don't know.

Joe Ham
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Location: New Mexico, USA

Re: IV VANCOMYCIN- I have questions PLEASE

Post by Joe Ham » Fri 13 Mar 2009 16:33

I don't know anything about Evan's previous therapies or even his age so I'm just talking thru my hat here.

Is it possible that the doc is doing a Hail-Mary play (desperation move) against suspected but unproven resistant strains of staph or strep?

"Vanco, Zith and Rif"
Have you checked the P450 dynamics and kinetics of that combo? especially Rifampin.
http://medicine.iupui.edu/Flockhart/table.htm

Fin24
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Re: IV VANCOMYCIN- I have questions PLEASE

Post by Fin24 » Fri 13 Mar 2009 18:20

the Dr isnt even thinking staph/strep and plain guessing by the seat of his pants

he takes what the last few Lyme pts tell him and then the next pt sees pcs of those protocols--not the best way to treat but its all we got

and he is ID and willing to use his Rx pad too

we are trying to educate him fast as we can

Joe favor?? I jhave partial vision with some Rifampin crap with my health today and near vertigo ( yet again) can you please dilute and summarize those P450's etc for me??

I trust your judgement/expertise meaning Id come to the same conclusions you would if only I could deal with metabolizing info and reading...

I do need to know all the ionteractions and kinetics asap

the timeline so far is today( less likely as the day goes on) or Mon first dose vanco at hospital infussion room then 3 days add zithro then 1 week after that rifampin

the Rif is for the Bart is all Im sure about

frankly with the risks of the vanco and the little bbb crossing I wasnt enthused about it--but we havent yet tried it and he claims a few of his intractable pts are getting some response--what that is or why--who knows

thank dear!!

hanegalen
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Re: IV VANCOMYCIN- I have questions PLEASE

Post by hanegalen » Sat 14 Mar 2009 14:10

hi fin
Hope everything goes well, and I know you have considered the issues over and over- and I am not goint to play the "wise guy", but...

You have taken part in the discussion in another post about bart, so you know my scepticism about Bart serology.In that respect toshos experience is telling,I think?
If you suspect bart there are ways to get closer to a diagnosis such as cultivation of the blood/biopsies on special media - think it is called "chocolate- agar".I have forgoten, did you make a postive pcr?If you are sure that the infection is of a bacterial one- maybe that is not so important.but if it is not?
The best of luck.
Gale.

Fin24
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Re: IV VANCOMYCIN- I have questions PLEASE

Post by Fin24 » Sat 14 Mar 2009 17:43

Gale

all thoughts are greatfully appreciated--you never know when one bit will help or lead to a breakthrough

we dont care about a positive--we are going on subjective symptoms and guessing at this point

in past we have gotten Pos on both PCR and WB and confirmed at least 3 times by 2 different labs so Im SURE it is or was Bart--plus Mine was blatantly the highest PCR theyve ever seen ( my LLMD is on a few of the original Bart papers--Dr E Eskow--) and Evan is congential so for him to also have the Bart--very very likely

and the kid got his own tick bite ages 2 or 3 ( who can recall that far back ;) ) and againm age 5

we lived in the hotbed of NJ Lyme in Ocean County and NO ONE was warned or told---I shudder to think the HOURS we apent lying all over the lawn and hiking with no protection AARRGGHH


as for bacterial vs viral--thats why Ill be asking to put antivirals on board soon enough too
besides if you recall he has an immune deficiancy syndrome ( CVIDS) that makes diagnostics murky at best and also makes multiple type infections likely ( fungal, bacterial, viral)

seat of out pants at this point Gale, seat of our pants

keep the thoughts coming--Im all for brainstorming

Joe Ham
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Re: IV VANCOMYCIN- I have questions PLEASE

Post by Joe Ham » Sat 14 Mar 2009 20:00

Easy on first.
I'm not a big fan of vancomycin. When I started looking at it because of recommendations on LNusa some years ago I didn't get any farther than its molecular weight of ~1500 and with no noted lipophilicity or influx mechanism I discarded it as an option for treating neuroborreliosis.

Later I heard (no reference) that it had been used in the 'olden-days' of Lyme research to keep mice alive in order to grow borrelia in their brains. That practice was abandoned with the development of BSK2 and BSKH. Too bad because there is now evidence that high passaged in vitro strains are significantly less virulent so the research conclusions are more suspect.

In other words, I wouldn't touch the stuff because I'm not interested in raising bugs in my brain (unless there was good evidence that I had a resistant strain of staph or strep).
frankly with the risks of the vanco and the little bbb crossing I wasnt enthused about it--but we havent yet tried it and he claims a few of his intractable pts are getting some response--what that is or why--who knows
Were there other undiagnosed non TBD co-infections? Suppression of immune mediated symptoms? Right, who knows.
Vancomycin-Induced Neutropenia

An easy way to use the Flockhart table is to use 'find' to step thru the listings. Doing that gives results for Rifampin as; substrate for CYP 1A2, 2A6 and inducers for CYP 2B6, 2C8, 2C9, 2C19, 2D6, 3A4,5,6. It seems to mess with the P450 enzymes more than any other drug, but that doesn't necessarily make it a bad thing if used correctly. I didn't. I did the Lymie thing of high constant dosing and ended up with some nasty coronary side effects. If I was a true Lymie I would have continued taking it at 300 mg bid and called everything a Herx with God knows what consequences.

For its indicated uses Rifampin is usually pulsed or cycled and that may be how I will use it if my Bart symptoms come back.
http://dukehealthsystem.adam.com/conten ... gid=112000
Rif is usually paired with Doxy for Bart. I chose Mino just because it has better BBB passage and I wanted to keep the pressure on borrelia while treating Bart.

I would not add an anti-viral to a soup of anti-bacterials. It's just not done (except maybe for HIV-AIDS) and so there is very little information about interactions.

If you have found a "compliant" ID duc you are very fortunate. The ID ducs here are too arrogant to even bother talking to. I use a DO who is recently from PA so he at least knows that Lyme exists even if he is not fully up to speed on the latest research and treatments. Nevertheless I play it very conservatively by not asking for something unless I can justify it.

For example I didn't ask for a Babesia test until I had a distinct symptom, midday sweats. The test from Igenex was 3 way positive. There have been 2 other examples like that. So by never being wrong in the past I have gained some credibility and I can now ask for something just to "try" it. He complies. But that puts the pressure on me to do the homework first. I suspect you do the same.

What is Evan's age now -- it's important.

[The above was written before Finn's last post.
Common Variable Immunodeficiency Syndrome. Talk about CYA writ large. I'll bet it does not have a recognized etiology.]

Fin24
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Re: IV VANCOMYCIN- I have questions PLEASE

Post by Fin24 » Sun 15 Mar 2009 0:54

sorry Joe thought Id mentioned before Evan is 19 1/2

as for the CVIDS--very reliable--he has the lymphocyte patterns and low IGG and 3 of the 4 IGG subests very low which indicative and we had him to a renowned east coast immunologist right beforte the guy retired who double confirmed--the only question is was he born with it or triggered by Lyme etal--and since I contraxted the lyme 8th mo preg with him...who knows

as infant he had hallmarks with infections etc but no one knew to look for it

( Im having a few hrs of visual field blindness and having great probs reading and typing so this may be scattred--sorry)no OTHER stroke sx tho :mrgreen:

seems to happen ever 2-3 weeks now and my neuro stumped

for ME--Over been on Rif now 2 months at 300 mg /day--plus my susual mino at 100-150 per day--Im thinking stopping the Rif for one-2 mo then return
what think you?? the nausea is getting to me and I wasnt able to tolerate rIF ever before--violent vomit etc and heart issues which by slwoly increasing Im avoiding mostly lately which is why i was able to go 2 whole mo but my gut is telling me we need a break...

you cant intermittent Rif w/o serioud kidney toxicity so how long a break you think is good??

back to evan best as I can

as for mixing antivirals with abx--docdave did that and more--his protocol while scary did have it all


thanx for the distilling of the Rif info
knew the gist was be careful as hell and watch the liver and kidney fx
the kid gets weekly bloods due to the PICC stuff anyway and once we start vanco, UA as well for kidney

at about 158 lbs and 19 Im guessing he is adult size so okay with all this
and we get DEHP free supplies to ( not that after all this plus TBI he will be able to procreate anywasy LOL)

Lymgm
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Re: IV VANCOMYCIN- I have questions PLEASE

Post by Lymgm » Mon 16 Mar 2009 14:55

Sorry this is a late contribution- I don't check this forum all the time. I adminster everything that goes in the PICC line with an admin set with a millipore filter. Since I am not making up the infusions in a hooded aseptic environment and am not prefiltering to remove any drug precipitate that may not visually go into solution, I feel much more comfortable with this. I reuse NOTHING. I have found an IV infusion company that provides all the IV supplies including the expensive admin sets and dressing changes, PICC tips, ect on a very reasonable per diem basis. Much cheaper than I can get the components individually even as a vet. Are you in the US? We are in Richmond, Virginia.

Fin24
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Re: IV VANCOMYCIN- I have questions PLEASE

Post by Fin24 » Mon 16 Mar 2009 18:13

thank you!!!! please email me the info at finrussak@aol.com

as for the vanco its ADDVantage system and supposed to be fool prroof aseptic--past 4 months Ive been reconstituting the tigacycline myself and no issues--I am an ex lab rat and recently have had to home care my cats ( IM and IV and subcut) so I have more training than the average "Mom"

but Id be greateful for info on supply co since my insurance isnt budging and the stuff costs more than the meds ( guess they know we need it and therefore demand vs supply costs


Finette

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