Question: About a month ago I contracted chlamydia with associated joint pain. I took a single 2g dose of azithromycin. Additionally, I have SIBO and constipation predominant IBS. The azithromycin helped with the chlamydia symptoms as well as the IBS symptoms, significantly alleviating my bloating. However, towards the end of the week I started having some urethral irritation again and fairly bad joint pain. I was having some stomach irritation and loose stool, and after consuming some lactose and fructose heavy food at a conference, my bloating returned and my IBS was worse than it was prior to the antibiotics. I then took a course of Cipro, 100 mg twice daily for a week. I also took Xifaxan simultaneously for the IBS 500 mg 3 times daily for 10 days. The Cipro seemed to help the joint pain but the two compounded the GI symptoms. I started having allergic type reactions to every food I ate, presumably an immune response to increased permeability associated with gut irritation. After I finished the Cipro, the joint pain returned along with some mild urethral irritation. I am allergic to Flagyl, so from what I've read my next option will be doxycycline. I have a doctor's appointment for next week. I'm considering asking him to prescribe me Rifampin for several reasons. They conducted a study which showed that chronic chlamydia-induced arthritis can be cured by 9 month combination therapy of doxycycline and rifampicin, Rifampin being useful due to its greater tissue penetration. Additionally, I read that among antibiotics Rifampin has the strongest action against chlamydia. However, it is not used in monotherapy, because of the rapidity with which bacteria develop resistance to it. I would also be interested in combination therapy, because my gut flora is already out of balance and Rifampin has been shown to prevent adverse GI effects of other antibiotics. I am curious about Rifampin, because I would like to hit the bacteria as hard as possible (and before the population fully recovers from the azithromycin and Cipro) to prevent developing chronic arthritis (if it works that way). My two reservations are as follows :1) that a short course of Rifampin would lead to resistance that would render long term use ineffective, if my arthritis becomes chronic and I need long term use and 2) that since I would be taking a relatively low dose compared to the similar Xifaxan, the bacteria in my gut would develop cross-resistance to Xifaxan. I think my GP is good, but this seems like a fairly specialized question, so I would appreciate info from anyone with knowledge in the area.

Cross-resistance is possible: http://www.ncbi.nlm.nih.gov/pubmed/0000. Fair point about dose vs. potency. But is 300 mg of Rifampin daily for a week comparable in potency to 1500 mg of Xifaxan daily for 10 days? Further, since the study which used Rifampin and Doxycycline to treat chronic chlamydia-induced arthritis was conducted over months (http://www.eurekalert.org/pub_releases/2010-04/uosf-cae042710.php) would it be reasonable to think that a week long treatment would do any good? My thought was that, since I started treatment early and after using other partially effective antibiotics, the bacteria would partially eradicated already, making it more susceptible to a shorter course of treatment. Could a shorter course risk resistance of the chlamydia or would the use of two antibiotics mitigate any risk? I know it will be up to my doctor, but this seems like esoteric stuff (the Rifampin study is only a few years old) and he might not have time to look it up. He always takes my thoughts on treatment into consideration, and I want to be informed enough to discuss it with him.