IV ANTIBIOTICS

[lemons]

COULD SOMEONE TELL ME ABOUT IV ANTIBIOTICS PLEASE. I HATE NEEDLES AND WAS HOPING I COULD AVOID AS MANY AS POSSIBLE. IF THE AP DOCTOR INSISTS ON USING IV FIRST, IS IT AN INJECTION OR A DRIP (IF THE LATTER,HOW LONG DOES IT TAKE?) AND HOW MANY TIMES UNTIL ORAL MEDS ARE PRESCRIBED? MANY THANKS.

[Maz]

@lemons wrote:

COULD SOMEONE TELL ME ABOUT IV ANTIBIOTICS PLEASE. I HATE NEEDLES AND WAS HOPING I COULD AVOID AS MANY AS POSSIBLE. IF THE AP DOCTOR INSISTS ON USING IV FIRST, IS IT AN INJECTION OR A DRIP (IF THE LATTER,HOW LONG DOES IT TAKE?) AND HOW MANY TIMES UNTIL ORAL MEDS ARE PRESCRIBED? MANY THANKS.

Hi Lemons,

The IV is a drip and usually a catheter will be inserted into the crook of your arm where they draw blood. I have found it is no more painful than having blood drawn and is painless once in the arm and also when removed. During the course of the 5-day series, the catheter remains in the arm and is just wrapped with an ACE bandage between IVs. Needs to be kept dry when showering to prevent infection at injection site. The medication is 900mg clindamycin (in saline) and dripped into a vein over the course of about 45 mins to an hour. The way Dr. Brown did it was to do two IVs a day for 5 days, but if folks are going into their doctor’s office daily, they may do one IV a day for 10 days instead or going back twice a day, just for convenience. If extended to 10 days, the IV catheter needs to be changed as it shouldn’t remain in the arm longer than 5 days in case of infection. It’s also changed at any time if the skin around the injection site begins to look irritated. I did a year of aggressive IV therapy and never had a problem with the IV injection site becoming infected, though once the catheter did slip out on the 4th day. It’s not a big deal if that happens and one just holds gauze over the site and then a bandaid. I took my own IV catheter out at the end of each series as I was using self-infusing boules at home that are like mini balloons that pump the medication in as they deflate slowly and attach easily to the extension line that attaches to the catheter. My doctor’s office is an hour away from home so it really saved having to drive up each day or the need for a home nurse.

The IV series is often done before orals are started when a person begins AP, but once on orals, if a repeat series of IVs is done, then the orals don’t need to be stopped, as tetracyclines are complimentary to clindamycin. The reason the orals are not usually taken when starting IVs for the first time is because if a person is going to herx, then will often do so the week after the IVs are finished. So, the person may wait till the IV herx passes before starting their oral abx so as not to create too much of a stir all at once, right at the outset.

The frequency with which people may do the IV clindamycin series depends on disease duration (how long the person has been unwell), severity of disease and degree of herxing with that first round. Some folks start to improve immediately, while others herx badly., so it’s a very individual thing. With severe, longstanding disease, it’s not unusual for RAers to begin with the 5 day series and then to have 1 or 2 IVs every month thereafter in addition to their oral abx. Others may do the 5 day series just once (e.g. in mild, early disease that responds quickly to treatment) and never need to do the IVs again as the orals are sufficient. Others may prefer to boost their orals every 3 or 6 months or annually with a 5 day series. In the Henry Scammell book, Dr. Brown describes how he used IV clindamycin to quench a flare that Carol Lange was experiencing at the time.

If you scroll to the bottom of the following newsletter, you will find a remission story of a lady with severe, longstanding RA and how she managed her IV therapy:

https://www.roadback.org/emailblasts/ebulletin_winter09.html

More info on the main site at following links:

http://roadback.org/index.cfm/fuseaction/education.display/display_id/123.html

http://roadback.org/index.cfm/fuseaction/education.display/display_id/118.html

https://www.roadback.org/index.cfm?fuseaction=studies.display&display_id=184#Anchor-Clindamycin-21683

Note: Dextrose, which may be more efficient for cellular uptake, is not usually preferred anymore in clindamycin IV solution, as it may promote candida. Saline is now used more often.

Hope this helps, Lemons…did you find a doc who will do IVs for you in UK?

[lemons]

Thanks Maz for info. Is the catheter always left in? Im starting to feel faint ! If its done every week (seven days) would they take it out on each visit ? I was hoping to just have tablets, see doctor in 3 weeks but apparently he like to use Iv treatment.

[Maz]

@lemons wrote:

Thanks Maz for info. Is the catheter always left in? Im starting to feel faint ! If its done every week (seven days) would they take it out on each visit ? I was hoping to just have tablets, see doctor in 3 weeks but apparently he like to use Iv treatment.

Hi Lemons,

If a person is doing the 5 day series, then yes, the catheter is usually left in the arm so that the person doesn’t have to be repeatedly jabbed on a daily basis and much kinder to one’s veins. If the IV series was extended for longer than the 5 days (e.g. for 10 days with one IV a day), then they would likely need to remove the original catheter and re-do it on the other arm half way through the series as they don’t like to keep them in for lengthier periods of time. If an IV is run one day a week, then the IV would be removed each time and re-done…i.e. not kept in the arm.

In case this helps, Lemons, IV clindamycin is the preferred route, if possible, because oral clindamycin can be hard on the gut in the longer term and is a more direct route to tissues than being broken down and absorbed through gut. Some folks do just fine with the 1200mg oral dose (in two doses of 600mg on one day per week) as long as they are using adequate probiotics, but should be aware that there can be a greater risk for C. Diff with the oral route. You can read about this abx here:

http://en.wikipedia.org/wiki/Clindamycin

http://www.drugs.com/clindamycin.html

The IV catheter is very small…really nothing to worry about. If just a single day IV is given, they usually only use a one inch catheter and it’s removed right at the end. The catheter just slides out with no pain…no more than a blood draw, anyway. After a while, it just becomes second nature having them done. If having the 5 day series, then the catheter is slightly longer (about 1.5 inches) to help prevent the chance of it coming out, but there is no difference in pain with this longer one either. It really is no more painful than having blood drawn…actually, I find it to be less painful by comparison as the needle used is smaller. You’re just conscious of the line being there when it’s wrapped between IVs really.

[Author]

Posts