Clarifying Question about Metronidazole (Flagyl) and 2nd Year Pulse

I've been reading through the Wheldon Protocal and I'm not completely clear on something that is likely to be obvious. 

When starting the pulse I understand that one would start with a one day pulse.

Is the second pulse one week later, or one month later?  Would the second pulse be 2, 3, 4 or 5 days?

Likewise, would the third pulse be in the third week, or third month?  I get the impression that it would last for 5 days regardless of how the first two went, yes? no? maybe?

Then after the first 3 weeks or months, is this recurringly done on a weekly or monthly basis?

second question while I'm thinking about this:

After one year, as I understand the chart on Dr. Wheldon's site, the Doxycycline and Roxithromycin become intermittant going 2 consecutive weeks every two months.  Included in the middle of this two weeks is 5 days of Metronidazole.  Meaning, in each two month period of the second year, there are 2 weeks of antibiotics and 6 weeks of nothing.  yes? no? maybe?

Thank you for all your replies to my very first post here.  I will get back to that thread soon.  Ken

Dr Wheldon recommends a 5 day pulse should take place every three to four weeks. Many people will fit a pulse into their life pattern, so as to be able to carry on as normally as possible. It is difficult to be categorical about the progression of the pulses, as everyone's reactions will be different. (<I know you accountant types>) you want numbers for everything, certainties and balance sheets. (< =tongue in cheek comment=>)

Here we are very much into listening to our bodies, watching for reactions, being flexible with our dosages. I think the golden rule is to take the two bacteriostatics Doxycycline and Azithromycin concurrently as soon as possible, because they work synergetically and prevent Cpn from developing a resistance to the ABX.

In the beginning it would be wise to go very easy with the Flagyl (Metronidazole) especially with someone who is very ill or has been ill for a long time. My daughter did not start the flagyl until she had done the other part of the protocol for 6 months (including supplements), we started with 2 tablets on the first pulse and a month later she took 4 tablets. Even at these small doses she had significant reactions that were very, very similar to a relapse, very scary. We waited another couple of months before starting the pulse again with 4 tablets, with each subsequent pulse we added another two tablets until she was taking 15 tablets over 5 days. It took over a year from the start of the treatment for her to work up to doing a full pulse.

Not everybody will have to go that slow, but I think from what I gather from TIMS, that Kim is not very well, so caution is needed. It might well be three or four years before she is ready to go on the intermittent protocol. So time enough to worry about the timing and dosage of the various drugs when you get to that point. In the meantime it is a question of gauging her response to the bacterostatics: if she tolerates them well, no problem start a tentative pulse and see how it goes. You might find however that even doxycycline and Azithromycin are giving her some unpleasant reactions and you may have to go slow to work up to the full doses. These two drugs will stop the Cpn infection from getting worse, and even have a small kill effect on it, so you can take your time.

Ella had some nasty reactions to Doxycycline and Azithromycin, but she was very ill. We stopped the Azi and just continued the Doxy for two weeks, before re-introducing Azi gradually. Now she tolerates all her antibiotics well and suffers only minor upsets during and after a pulse. The interval between pulses is important to give the body time to recover. Some die off effects may not show up for at least a week, sometimes longer.... And although the die off effect will stop, the recovery from these might take a few weeks.

Michele (UK) GFA: Wheldon CAP 1st May 2006. Daily Doxy, Azi MWF, metro pulse. Zoo keeper for Ella, RRMS, At worse EDSS 9, 3 months later 7 now 5.5 Wheldon CAP 16th March 2006

Michèle (UK) GFA: Wheldon CAP 1st May 2006. Daily Doxy, Azi MWF, metro pulse.

Ok, Ken , I have numbers for you. I have done 46 pulses of flagyl and the only times I have varied my schedule were both this summer. Every 3 weeks, though sometimes it was a few days longer because I just didn't feel up to it. This summer, a full 3 years on a very strict protocol, I extended so I could go to the goat National show. I have had incredible recovery, but because I still have great reaction to flagyl, have no intention of slowing anything down. As a matter of fact, I plan to add Rifampin this fall, after the State Fair show, which will put me back on the protocol I started with. Maybe by then, with another year or so behind me, I will go on intermittent, but I am certainly not ready yet.


Rica PPMS EDSS 6.7 at beginning - now 2. Began CAP Sept, 2004 with Rifampin 150 mg 2xd, Doxy 100 mg 2xd, added regular pulses Jan 2005. Jan 2006 switched to Doxy, Azith, cont. flagyl total 46 pulses NC USA

3/9 Symptoms returning. Began 5 abx protocol 5/9 Rifampin 600, Amox 1000, Doxy 200, MWF Azith 250, flagyl 1000 daily. Began Sept 04 PPMS EDSS 6.7 Now good days EDSS 1 Mind, like parachute, work only when open. Charlie Chan  In for the duration.&am

Ken, The first pulse is now generally just one day, just one pill, although I did five days, full dose, because then we didn't know how hard some people would be hit. Luckily I wasn't.  Then the second pulse, three weeks later, can be more, depending how the first pulse was tolerated.  Maybe one pill a day for five days or three pills for one day, then build on that.  Also the three weeks don't have to be exact: it depends what else is going on, holidays, alcoholic parties and so on.     You change to intermittent schedule when you no longer get reactions to metronidzole, which was a year for me, despite having been very ill.  With some people will take much longer.....Sarah (still writing largely with one hand but much better and an almost rebuilt computer, so still trying to keep it short!)   An Itinerary in Light and Shadow   Finished Stratton/Wheldon regime for aggressive secondary progressive MS in June 2007, after four years, three of which intermittent.   Still slowly improving with no exacerbation since starting. EDSS was 7, now 2, less on a good day.
Completed Stratton/Wheldon regime for aggressive secondary progressive MS in June 2007, after four years, three of which intermittent.   Still improving bit by bit and no relapses since finishing treatment.

Thank you!

 I'm new to all this, so please forgive me for wanting to clarify until I get this exactly right.

I think as I understand this now, the idea would be:

First time to take 1x 400 mg tablet.  If that seems to be tolerable take a second one the same day and if that seems tolerable take a third one that day and stop.  Then wait 3 weeks.


Second time, repeat process above, but shoot for 2 days or maybe 3 or more unitl its not tolerable.  Don't go beyond 5 days (15 400 mg tablets).  Then wait 3 weeks.

Third time and thereafter, repeat the second time.  Am I getting a handle n this?  Ken 





In pursuit of ABX

Don't Allow What You Know To Get In The Way Of What Might Be

Yes, you are getting there, but I would still be cautious for the first pulse, as Sarah says one pill, one day then wait for three weeks, if there were no drastic reactions then next time you can increase the dose.   But the problem is that nasty reactions can take more than a few hours to manifest themselves, in fact sometimes you can have more energy when on Flagyl and three days later some symptom of die off shows itself.   It is hard to be exact and none of us want to frighten you as not everyone has nasty reactions, and you might feel that like Sarah you want to take the chance just to get on the way more quickly.   When Sarah did it, no one was aware of the extent of the effect Flagyl could have on different people, so in away it was easier for her.  No easy but easier... ignorance is bliss they say.

Michele (UK) GFA: Wheldon CAP 1st May 2006. Daily Doxy, Azi MWF, metro pulse. Zoo keeper for Ella, RRMS, At worse EDSS 9, 3 months later 7 now 5.5 Wheldon CAP 16th March 2006

Michèle (UK) GFA: Wheldon CAP 1st May 2006. Daily Doxy, Azi MWF, metro pulse.


Welcome, I will just pass along my experience with my first pulse about 4 weeks ago.  I took one pill & things seemed OK until day 8 then I was slammed with a delayed die off reaction.  That combined with the fact I was forced to go to an aggressive physio program which was a very bad idea.  I still have not done another pulse as I am waiting to get stronger.

I am still having reactions with the doxy & azith together & that is all I am handling at the moment.  It takes alot of my energy...most actually to deal with the die off.  I am not yet back to work.

You will know when the time is right, I did for my first pulse.

Grace & Peace


CFIDS/ME 25yrs, FMS, IBS, EBV, Cpn, (insomnia - melatonin, GABA, tarazadone, temazepam, novocyclopine, allergy formula, 2 gm tryptophan), Natural HRT peri-M, NAC 2.5 gm, 6-07 Doxy 200 mg day pm, Azith 375 mg M/W/Fday, 8-21-07 1st pulse 1 X 250 mg Metro

CFIDS/ME, FMS, MCS, IBS, EBV, CMV, Cpn, H1, chronic insomnia, Chronic Lyme, HME, Babesia, Natural HRT-menopause, NAC 2.4 gm,Full CAP 6-2-07, all supplements+Iodorol, Inositol-depression, ultra Chitosan, L lysine Pulse#27 04-19-10 1gm Flagyl/day-5 days<

And, for balance... I started the whole protocol at once. Doxy and azith at full dosages for six weeks, then did a full five day flagyl pulse with no huge ill effects. I remember feeling very sleepy the last couple of days of flagyl and a little wobbly on my feet. Since your bride has had this a while, I would suggest a cautious approach. I would personally never be so cautious as to only do one flagyl and call it a pulse, but that's because I'm simply incapable of thinking one will do when fifteen pills are available! If I were you, I would read Michele's account of Ella's story very carefully for clues. She obviously had a heavy load to clear from her body and I would venture your wife is in the same boat.

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

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