As you know, the original Vanderbilt regimen developed by Dr. Stratton's group slowly added each new antibiotic until a continuous program was reached, including the metronidazole. David Wheldon's modification pulsed the metronidazole, after slowly adding the new antibiotics. For patients who have severe reactions, I would recommend slowly adding the metronidazole in the pulses – for example, the first pulse might just be one 500 mg tablet of metronidazole. Dr. Stratton has agreed (see his comments on the differences in the two protocols) that pulsing the metronidazole is quite acceptable and achieves the same end results as gearing for continuous use.Also, the pulses don’t have to be rigid – plan them around life events like holidays, birthdays, job requirements, etc. Once you learn when the reactions hit – like on the fourth day after starting, plan for this day to be on a weekend. For those that can get INH, a “double pulse” of metronidazole/INH might be more effective, but do a slow pulse rather than a full pulse.