Submitted by Jim K on Sun, 2007-07-22 11:12

We have been preparing this for an eventual overhaul of the Handbook, but there have been a number of requests, especially by new folks, to help clear up confusion. Combination Antibiotic Protocols-These charts are presented to give the brain-fogged an overview of protocols to understand the general approach, and why you may read of people on www.cpnhelp.org as using differing combinations of meds. These charts are meant for clarification only and should not be used as a starting point for doing a CAP protocol. Everyone’s case is different, and requires individual considerations. Also, understanding the many facets of Cpn and treatment reactions is crucial before engaging in treatment. Don’t start any of these without reading further in the Cpn Handbook. Summary chart of different CAP protocolsNote:Jim, I'm sorry not to have read this sooner, but you appear to be making a mistake about David's regime.  You don't mention NACi until way down the list and the first alternative is given appears to be azithromycini by itself, which is incorrect as can be seen here: http://www.davidwheldon.co.uk/ms-treatment1.html

A schedule of treatment.This is one schedule which strikes all stages of the organism's life-cycle. Other equally good schedules are possible. It is preferable that a committed care-giver (for instance, spouse, partner or parent) should ensure that medication is given, and swallowed, consistently.) N-acetyl cysteine (NAC) 600mg - 1,200mg twice a day, should be taken continuously. This is a commonly-taken dietary supplement, available at health-food stores. It is an acetylated sulphur-containing amino-acid, and may be expected to cause chlamydial EBs to open prematurely, exposing them to starvation; more on this and other benefits on page 4. This should be started at the lower dose of 600mg twice a day; the dose should be doubled when well-tolerated. NAC offers liver protection; this may be useful, as rapid bacterial die-off may compromise hepatic function. When NAC is well tolerated, Doxycyclinei 100mg once daily is added. It is taken with plenty of water. When the two above are well tolerated, Azithromycin 250mg orally, three times a week should be added. (Roxithromycini, 150mg twice daily, is an alternative.) When all three agents are well tolerated, the dose of Doxycycline is increased to 200mg daily. The reason for this slow, step-wise introduction of antichlamydials is to minimize any reactions caused by bacterial die-off. These can be unpleasant. NOTE: in rapidly progressive MSi it may be prudent to offset the benefits of stopping progression against the risk of reactions, giving full doses of azithromycin and doxicycline from the beginning. This combination is taken continuously.

Also, The implication might be taken by some people that metronidazolei and tinidazolei are taken during a five day break fro the bacteristatics an this also applies to the Stratton Protocol.  This would seem to answer my query as to why so many newbies were asking me this question..........Sarah    

Comments

Jim,  Thanks for doing this.  Now...if people will only refer to it and read it.... Joyce~caregiver-advocate in Dallas for Steve J (SPMS).  CAP since August 06, antivirals, heavy metals chelation, LDN, Metanx, Lunesta, GF/CF diet, Lauricidin, oral IgG/lactoferrin/IGF-1 booster, astaxanthin, gamma oryzanol.

Joyce~caregiver-advocate in Dallas for Steve J (SPMS).  CAP since August 06, Cpn, Mpn, B. burgdorferi, systemic candidiasis, EBV, CMV & other herpes family viral infections, elevated heavy metals, gluten+casein sensitivity. 

Thanks Jim,
This is excellent!

On Wheldon protocol for MS since April, 2006.  doxy 200 mgs daily, zithromax 250 mgs 3x/ week , Flagyl Pulses start end Sept., LDN 2004

5oo mgs Ceftin 2 x/day, 500 mgs Zithromax, 500 mgs 2 x tini pulses,100 mg diflucan, 4.5 ldn; Wheldon protocol for MS April, 2006 to May 2008. 2008 MRI shows NO NEW DISEASE ACTIVITY, 2012 MRI no new disease activity.

Very good addition Jim.  I've wanted to compare protocols and see their differences and commonalities, and this chart brings it home.  Good work! all my bestJohnRRMS/EDSS was 4.5, now 4.??? on Wheldon Protocol (nac, doxycycline, azithromycin, metronidazole) since 04/12/2006

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

  Jim, I'm sorry not to have read this sooner, but you appear to be making a mistake about David's regime.  You don't mention NAC until way down the list and the first alternative is given appears to be azithromycin by itself, which is incorrect as can be seen here:http://www.davidwheldon.co.uk/ms-treatment1.html

A schedule of treatment.This is one schedule which strikes all stages of the organism's life-cycle. Other equally good schedules are possible. It is preferable that a committed care-giver (for instance, spouse, partner or parent) should ensure that medication is given, and swallowed, consistently.)N-acetyl cysteine (NAC) 600mg - 1,200mg twice a day, should be taken continuously. This is a commonly-taken dietary supplement, available at health-food stores. It is an acetylated sulphur-containing amino-acid, and may be expected to cause chlamydial EBs to open prematurely, exposing them to starvation; more on this and other benefits on page 4. This should be started at the lower dose of 600mg twice a day; the dose should be doubled when well-tolerated. NAC offers liver protection; this may be useful, as rapid bacterial die-off may compromise hepatic function.When NAC is well tolerated, Doxycycline 100mg once daily is added. It is taken with plenty of water.When the two above are well tolerated, Azithromycin 250mg orally, three times a week should be added. (Roxithromycin, 150mg twice daily, is an alternative.)When all three agents are well tolerated, the dose of Doxycycline is increased to 200mg daily.The reason for this slow, step-wise introduction of antichlamydials is to minimize any reactions caused by bacterial die-off. These can be unpleasant. NOTE: in rapidly progressive MS it may be prudent to offset the benefits of stopping progression against the risk of reactions, giving full doses of azithromycin and doxicycline from the beginning.This combination is taken continuously.

Also, The implication might be taken by some people that metronidazole and tinidazole are taken during a five day break fro the bacteristatics an this also applies to the Stratton Protocol.  This would seem to answer my query as to why so many newbies were asking me this question..........Sarah      An Itinerary in Light and Shadow   Stratton/Wheldon regime since August 2003, for aggressive secondary progressive MS.  Intermittent therapy after one year. 2007 still take this two weeks every three months. Still slowly improving with no exacerbation since starting. EDSS was 7, now 2

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.

 Rats! To change it will require a bit of time, as I had to convert the Word chart to an image to insert it. CAP for Chlamydia pneumonia since 11/04. 25yrs CFS & FMS- Currently: 300mg INH, 200 Doxycycline, 500mg MWF Azithromycin, 1000mg Tini daily (Taking a break from continuous protocol)

Jim, how about moving my comment to imediately below the chart until you have the time?..........Sarah   An Itinerary in Light and Shadow  Stratton/Wheldon regime since August 2003, for aggressive secondary progressive MS.  Intermittent therapy after one year. 2007 still take this two weeks every three months. Still slowly improving with no exacerbation since starting. EDSS was 7, now 2

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.

Thanks Jim!  Now if I get less mail on the subject, it'll prove that people have read the update...........Sarah

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.

Greetings  :-)I have just begun the Wheldon Protocol today. This would never have been possible without being able to persuade my doctor to allow this....which was 100% based on the information found on this site. To say I am very appreciative is as much of an understatement as it is to say that I sorta' hope my symptoms improve now.  Ha!   Thank you to everyone here!My question relates to the order in which to introduce each component of the Protocol. Specifically, my question relates to something Sarah said here:

Also, The implication might be taken by some people that metronidazoleii and tinidazoleii are taken during a five day break fro the bacteristatics an this also applies to the Stratton Protocol.  This would seem to answer my query as to why so many newbies were asking me this question..........Sarah 

Assuming everything else is well tolerated as added, at what point should we begin to add the Flagyl pulses? And once that phase (Flagyl pulses) has begun, is a separate component (i.e. one that we would be taking at the time Flagyl is added) supposed to be reduced, suspended, or eliminated....and if so, is it then restarted when we rae not active in a Flagyl pulse? CHEERS!D

 CHEERS!D CFS, Hypothyroid, Started CAP 10/01/07 Doxy 200 daily, NAC 2400 daily, Azithro 250 M-W-F, T3&T4 250mcg daily, opti-frickin-mistic!

Hello D, welcome to the madhouse!Easy answer:  I started metronidazole three months after the bacteristatic abx, but you never, ever stop taking these whilst taking metronidazole (flagyl)........SarahAn Itinerary in Light and Shadow    

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.

Sarah.....I love your reply because it is so "unvague".  Lol!!  Thank you. :-)CHEERS!D

 CHEERS!D CFS, Hypothyroid, Started CAP 10/01/07 Doxy 200 daily, NAC 2400 daily, Azithro 250 M-W-F, T3&T4 250mcg daily, opti-frickin-mistic!

This is an easy one. Start doxy, when tolerated, add azith to the doxy. Azith is only taken on Mon, Weds, Fri. When both of those are well-tolerated, take a five-day long hit of metronidazole every fourth week, while still taking the other antibiotics.

You may be confused by the people here who occasionally have to cut back on their abx, due to overwhelming die-off reactions. That is not the norm, nor is it the way the protocol is laid out. It's simply an accommodation that might need to be made for those who are having too hard a time of it.

Congratulations on starting! We're here to help you through it. I'll be sending you the 'official' welcome letter, so look for it in your private mailbox here.

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

Is there any reason not to take the doxy, NAC, and azyth all at the same time? I just started the doxy and azith today and downed all three at once wiht a cracker and plenty of water.... was that a bad idea in general??thanksMelissa

MelissaHIGH EBV 2/08,card/resp sx,numb hand,musc twitch/pains,neg for ms/lupus,scans hd 2 toe, abd/jnt/lymph pain, dizzy/fatigue, lymph swelling, lyme susp 9/08- igx-1 ++, cd57 52, CMV+, HHV6, MYCO-CAP11/08 NAC,Dxy,Zith MWF+sups

Ditto.  I also take supplements along with, but avoid the ones containing calcium/magnesium as these can interfere with absorption of the antibiotics.  

NAC 2.4g, Zith 250mg/MWF, mino 200mg, Tini 5day/1g/5 pulses, ValcyteSupplements, CFIDS/FMS, Hashimoto's, Psoriasis, PA, IBS, Sec Addisons Don't believe everything you think!  

I take my calcium, magnesium, iron, B complex, and acidophilus late in the evening, twelve hours away from doxy, in a perfect world. Four hours away is about my minimum separation, when life is occasionally less than perfect.

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

Hi, some are under the impression that it doesn't make difference. If you read the instructions, you find that doxy needs to be taken with food. Without it, I have encountered nausea.. Flagyl and Roxi without food, as it would have less absorption.Instructions, are the way to go....sometimes what is best for you individually is the way to go...Thanks, .dana

I understand that magnesium and calcium can interfere with abx absorption so I take abx at dinner time and the calcium about 4 hours later.  I wonder if that is enough separation. Brian

ExRacer - MS dx 2002.  EDSS: 6.0.  LDN since 2004, NAC, Doxy, Azi MWF, Recommended supplements.  Completed Flagyl pulse 22 on 10/26/09. 

Thanks guys:)I guess my internalist is the gung ho type:) because he had me on amoxycillin and NAC and then adding doxy and azyth at the same time right on... I have made the personal decision to get off the amox since the NAC is doing the same thing and already my stomach feels better and less bloated- after almost 3 months of amoxycillin.  yeah:) Also-- not really having hte same reactions that i had with the NAC - of course this is only day 2 on the doxy so-- we will see:) NOt much pain or weird feelings-- but it took a while with the NAC and the amox too and then it all came back like a mini series of all of the previous symptoms almost....Those have subsided alot thankfully- ache/pains/etcBlessings allMelissa

MelissaHIGH EBV 2/08,card/resp sx,numb hand,musc twitch/pains,neg for ms/lupus,scans hd 2 toe, abd/jnt/lymph pain, dizzy/fatigue, lymph swelling, lyme susp 9/08- igx-1 ++, cd57 52, CMV+, HHV6, MYCO-CAP11/08 NAC,Dxy,Zith MWF+sups

Bumping this up for reference to recent forum question.

  • CAP(TiniOnly): 06/07-02/09 for CFS
  • MethylationProtocolSupplements: Started08/08
  • Intermtnt CAP: 02/09-02/10
  • Full MethylProtocol & LDN 02/09
  • Off CAP: 02/10, cont LDN & MethlyProtocol support

Now that Doxy is unattainable in the US, is there something that could be substituted for it. I know it's possible to order from off continent, but prices there are even skyrocketing. Eventhough Doxy is from the Tetracycline family, I want to know if others in the family will serve our needs for CAP.

DD

It is NOT unattainable.  There is a temporary shortage.  Many large pharmacies do have it available for sale, however.

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

According to this: http://www.ashp.org/DrugShortages/Current/bulletin.aspx?id=977 the temporary shortage should be over by April, which is very soon....................Sarah    Journey through Light and Shadow  

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.