MediTest
27 Apr 2018
Author
nord
Title

Abx combinaton for Lyme

Body

Do Tetracyclines and Macrolides have the same benefit in combination (synergistic effect) when used for treating Lyme? As I understand Quinolones are a possible alternatives to Tetracyclines against Cpn RBs, is that so (so that a Quinolone and a Macrolide are used to target the RBs with synergistic and restistance-preventive effect)? Is there an additional benefit from using a combination of Tetracyclines instead of just one (e g Minocycline plus Tetracycline)?  Thank you for input

Comments

Science-minded brains, please comment?

The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi

No additional benefit from using two tetracyclines as opposed to one.  Two tetracyclines together would encourage resistance to emerge whereas a marolide and tetracycline has a much smaller chance of that happening.

best, JohnRRMS/EDSS was 4.5, 5, 6, 6.5, 6.9999, 6.5 on Wheldon/Stratton Protocol beginning 04/12/2006nac 4x600 mg/daydoxycycline 2x100mg/dayazithromycin 3x250mg/day MWFmetronidazole 3x400mg/day then 3x500mg/day

"As I understand Quinolones are a possible alternatives to Tetracyclines against Cpn" Quinoloines are not recommended for long-term treatment...

JeanneRoz ~ DX'd w/ CPN 4/2007; 6/07 -"officially" dx'd w/CFIDS/FM; also: HHV6, EBV, IBS-C, 100 Doxy:BID; 500 mg Biaxin BID; Tindamax Pulses, B12 shots, ERFA Dessicated Thyroid,Cortef, Iodoral 25 mg, Vit D-6,000 uni

Thank you all!John, I suspected just that. I'll have to ask in the German Lyme forum as many use exactly that combo Doxy+Tetra (and it seems sometimes without any other antibiotic)! Will steer clear of this.JeanneRoz, I understand that the Quinolones are not good for long-term use (especially as I have quite a bit of achilles tendon/insertion involvement...), so it is an idea for a shorter course (1-2 months) as it is very active against Lyme and reaches the CSF well (I have some symptoms of this, and even if slight, quickly increasing). But this will be a later consideration, if and when my tendons have improved. The idea is then to exhange one of the other antibiotics for that period. A good Cpn combination will form the foundation for the treatment is my goal, as I suspect it is present (even if serology in the UK was neg).  I'll see a Lyme doc in a few days, the previous one in the UK has retired his Lyme practise (or is about to), so I am arming myself with knowledge and quiestions. :-)  I think it looks like the updated Wheldon protocol is a good start both against Lyme and Cpn: Supplements (inc NAC) then slowly ramping up Doxycycline/Minocycline+Clindamycin/Roxithromycin+pulsing Metronidazole/Tinidazole. 

Borrelia/Cpn arthritis: joint, skin, eye, CNS, respiratory, UG involvment; fatigue. Borrelia: Clinical, Elisa&WB IgG, and CPn IgG and IgA pos, HLA-B27 neg. (2010). CAP 5/9/2010 -> 3/2016 2017: some signs and symptoms returning, Borrelia?

A few additional thoughts: having Lyme and most probably B. afzelii and B. Garinii (from Western blot, as the bands showing are specific to these strains), and finding that Roxithromycin is less active against Borrelia, I wonder if it would be reasonable to switch to Azithromycin. [MURGIA, MARCHETTI, CINCO: Comparative Bacteriostatic and Bactericidal Activities of Cefodizime against Borrelia burgdorferi Sensu Lato; ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, Dec.1999,p.3030–3032]. It seems like Azithromycin 250mg MWF it will create a much harsher environment for Borrelia than Roxithromycin 150mg bid.As far as I understand the preference for Roxithromycin is because of better BBB penetration, which with more recent insight seems comparable for Azithromycin? Are there other considerations that may be important? Have tried to search the site. My current combo is Roxithromycin 150mg bid and Minocycline 100mg bid and Hydroxychloroquine 200mg (plus supplements), and have Tinidazole (for later pulsing). Have been on this combo for two weeks, Doxycycline 100mg, later 200mg, plus Hydroxycloroquine for ten days before that.   Thank you.

Borrelia/Cpn arthritis: joint, skin, eye, CNS, respiratory, UG involvment; fatigue. Borrelia: Clinical, Elisa&WB IgG, and CPn IgG and IgA pos, HLA-B27 neg. (2010). CAP 5/9/2010 -> 3/2016 2017: some signs and symptoms returning, Borrelia?

Azithromycin works well for me, i started with roxy but switched due to some side effects, which may just have been dieoff, cant comment on the BBB but since it can make me a little bit dizzy after i take it i would suppose it gets there.....

Treating PPMS with Azithromycin, Minocycline, Rifampin.

Nord, perhaps you may find this link of interest (pages 12 &  13)   Dr. Burascano is one of the "experts" on treating Lyme.   JeanneRoz

JeanneRoz ~ DX'd w/ CPN 4/2007; 6/07 -"officially" dx'd w/CFIDS/FM; also: HHV6, EBV, IBS-C, 100 Doxy:BID; 500 mg Biaxin BID; Tindamax Pulses, B12 shots, ERFA Dessicated Thyroid,Cortef, Iodoral 25 mg, Vit D-6,000 uni

Thank you for the comments and help!I just switched to Azithromycin after being on just Doxy for a week as I ran out of Mino and Roxi and there was a strike or another probably delaying supplies (but for comments of the possibility to leave the Azi out for a while for people with difficulties standing herxing/porphyria from the addition of Azi, it seems to be less of a problem). During the absence of a macrolide some symptoms returned: a little more joint discomfort (was almost gone), and returned night sweats (albeit only slight)that are probably for Borrelia or "BLOs".   A few comments on the Burrascano guide. A lot of interesting points, but it lacks a bit in structure and particularly references.  Also, many Borrelia experts come from different backgrounds than microbiology, and their teachings lack the detailed understanding that is part of the basis for the elegant Cpn treatment protocols. E g the combination of a Tetracycline and a Macrolide seems to have the same benefits in Borrelia treatment, but instead mega-doses of Doxy even i.v.s are recommended for Borrelia (up to 600 mg per day "or even higher", whereas, accrding to Wheldon, combining increases the efficiency fourfold, so 200mg doxy and 250mg Azi MWF is comparable to 800mg Doxy per day).  It is also known that Cpn is often present when Borrelia is, so the resistance considerations regarding Cpn alone is a reason to add a macrolide in Borrelia treatment, in my view. Also, Cpn is similarly difficult to diagnose as Lyme, and by this Cpn infection is probably underdiagnosed in chronic Lyme patients (so Cpn is probably even more commonly present than is known from studies). Still useful insights.  There many interesting papers by the German Lyme Docs (Berghoff, Klemann, Hopf-Siedel...) with a lot of interesting additional points (and lots of references, particularly by Berghoff). Only in German, though. 

Borrelia/Cpn arthritis: joint, skin, eye, CNS, respiratory, UG involvment; fatigue. Borrelia: Clinical, Elisa&WB IgG, and CPn IgG and IgA pos, HLA-B27 neg. (2010). CAP 5/9/2010 -> 3/2016 2017: some signs and symptoms returning, Borrelia?