Q. Do I take Doxycycline on an empty stomach?
A. No, always take it with food, or at the minimum a glass of milk. Do not lie down for at least 20 minutes after taking it. It is OK to take it with dairy food.
Q. When we add Azithromycin to Doxycycline do we take them at the same time?
A. Yes, you can take them at the same time. Latest instructions say that you can take it with or without food. If you are having trouble assimilating both at the same time they can be taken separately.
Q. Do I have to take all the antibiotics?
A. The short answer is yes. This is a Combined Antibiotic Protocol (CAP)and you will need to take the two bacteriostatic antibiotics continuously for the duration of the treatment and Flagyl in pulses. Less than that risks incurring resistance and incomplete clearance of Cpn. There are of course other antibiotic protocols that use four or more antibiotics but we would not recommend these initially.
Q. Do I take Doxycycline and Azithromycin for three weeks, then stop them to take five days of Flagyl?
A. No. You always take your Doxycycline and Azithromycin, then you ADD IN the Flagyl pulse. During the pulse, you are taking all three meds each day. Consider the month to be 28 days long. On days 24 through 28 you take Flagyl along with your other medications.
Q. What if I have to stop taking the antibiotics for a while? Will Cpn become resistant to them?
A. It is not a good idea to stop and start the antibiotics, but Cpn will not become resistant to the antibiotics very quickly so that odd occasion should be alright.
Q. Do I have to take NAC?
A. No, it is not essential, but it does have a direct action on EBs and therefore may help to reduce the length of time you have to do the CAP. It is also beneficial to the liver.
Q. Can you tell me what the supplements do?
A. You can find a quick guide to the roles of supplements here.
Q. Where to buy supplements?
A. Most people, even people not living in the US find that the following three sites are much more economical, provide more suitable dosages and good quality supplements than those found locally:
Here is a link to a cpnhelp.org page which takes you directly to the recommended supplements at vitacost.com.
Q. Do I have to take all the supplements?
A. Take as many of them as you can afford. If you look at the supplements page here, the ones that are highly recommended are in bold letters.
Q. Will I have reactions to the CAP?
A. Many people do, but not everyone will. Everyone is different, and each will have different reactions depending mostly on the Cpn load and the sites of infection.
Q. Why do I have to feel bad before I feel better?
A. Cpn will not go quietly. It is difficult to kill and when it dies it releases toxins into your body which makes you feel ill. The longer the treatment goes on the less ill you will feel because you will have fewer and fewer Cpn bacteria to kill.
Q. Why is my urine a strange colour at times?
A. Your urine reflects food, medication and supplements that you swallow.
- YELLOW as a result of taking Vitamin B complex
- GREEN sometimes as a result of eating certain green vegetables, or NAC.
- BROWN/PURPLE often happens during Flagyl pulses especially at the beginning of treatment, can be a sign of porphyria. People who are at the end of their treatment report that their urine is clear when taking Flagyl. This suggests that it is not the medication producing the brown colouration but the porphyrin by products in your system.
- ORANGE/RED as a result of taking Rifampin
Q. I started on Doxycycline and Azithromycin and don't notice any reactions.
A. Not everyone will get reactions to either or both of these two. They are mostly anti-replicative antibiotics and therefore do not kill many Cpn bacteria, so not many toxins get released into your blood stream and you feel OK. These drugs can also kill other organisms and people who get strong reactions may be killing other stuff as well as a few Cpn bacteria. Alternatively, people who are very sick are very sensitive to any change in their bodies and can be quite ill with even minimal added toxin levels.
Q. I always get thrush when taking antibiotics, can I prevent it?
A. Some people seem more prone to thrush (Candida Albicans) than others. A good regimen of probiotics and antifungals usually keeps the problem under control. Here are a few supplements that might help: S Boulardi, Tanalbit, Kolorex, Caprylic acid, Acidophilus, Kefir (a yoghurt like drink), Yaeyama Chlorella, turmeric etc. Additionally your doctor can prescribe flucanozole to take if the problem is serious. In my experience Flagyl is very good at beating back Candida, and I would always follow a pulse with a vigorous anti candida regimen.
Q. What is the difference between side effects of the drugs and die off symptoms and how can I know if I am allergic or just getting die off effects?
A. If your symptoms match those described in the reactions page then you can be pretty sure that you are suffering from die off effects. Many commonly reported side effects to antibiotics, we speculate, could in fact be Cpn die off, although because people are unaware that they have a Cpn infection it could easily be attributed to an allergy. We have repeatedly heard it said here that people who were ‘allergic’ to antibiotics no longer are when they have been on the CAP for a couple of months. People who are very sick in the beginning of treatment should be careful when starting the antibiotic to start slowly so as not to overwhelm their system.
Questions answered elsewhere
Q. NAC flu - what are the symptoms? I'm feeling nauseous what can I do? I have constipation or diarrhoea? What is porphyria, what can I do about it?
A. Look in the Reactions page
Q. Do I take the antibiotics twice a day or can I take them together in one go?
A. In the beginning it would be prudent to take the antibiotics separately, twice or three times a day. When you have become accustomed to taking them and can monitor your reactions effectively then you can take your antibiotics in one dose. Some people would argue that you get a better coverage by taking it twice a day. But the difference would probably not be too great.
Q. There are so many pills to take, can you help me with some examples of what to take when?
A. Here is a thread which gives a couple of schedules used by some of our members to space out their medications and supplements. Your lifestyle will dictate the timing of your medication to a certain extent. It is important to keep Calcium/Magnesium separated by at least two hours from Doxycycline. Don’t take acidophilus at the same time as antibiotics, before bed might be a good time. Charcoal is like a sponge: it will absorb anything it comes into contact with, so it is best taken several hours away from other medication. Quite a few people have it ready by the side of their bed and take it in the middle of the night.
Q. When will my treatment end?
A. This is a difficult question to answer as each person will be different. Expect the treatment to last months and years, rather than days and weeks. Some indication that you are nearing the end of the treatment would be when you no longer get reactions from Flagyl or Tinidazole and your urine is no longer brown/purple during a pulse of these antibiotics. You may wish to go on an intermittent protocol at that point for up to a year, or do a trial of more potent anti-chlamydials to 'test' your lack of reactivity.
Q. Can I take painkillers while on this treatment?
Q. Am I allowed to drink alcohol?
A. After a few months of treatment an occasional drink won’t harm, but initially I would say it was inadvisable. It is particularly contra-indicated when taking Flagyl or Tinidazole as it could make you feel sick and even make you vomit.
Q. Can I go out in the sun?
A. When you first start taking Doxycycline you must stay in the shade, cover up or use very strong sun block or you will end up looking like a beetroot and the colour will not disappear for weeks. It is not like ordinary sunburn, and although the sting will disappear in a couple of days the colour will not. After a few months of treatment the problem seems to abate somewhat but take care all the same. Some people get less sun sensitive over the course of the treatment as photoreactive porphyrins that have built up in the skin are diminished.
Q. How do I get diagnosed?
A. One way to tell if you have a Cpn infection is to do the NAC (N-Acetyl Cysteine) test. NAC kill the Elementary Bodies (EBs) stage of Cpn. If you have reactions such as sneezing, maybe itchy eyes and a sore throat, then you are most likely suffering from a Cpn infection. NAC is an otherwise benign agent, that to our knowledge, only produces these kinds of reactions to Cpn. If you don't have a reaction to NAC that may be because you don't have a high EB load. So it's not an absolute indicator.
Q. What tests can determine if I have Cpn and can distinguish a latent from an active infection?
A. Cpn is difficult to detect. Dr Stratton recommends a serologist test as being most consistent in detecting Cpn. In the US Mayo labs and Quest labs seem to have to most consistent results. The main indicator for a persistent Cpn infection is elevated IGG levels. Most physicians will inaccurately call this elevation an indicator of past Cpn infection and not meaningful, but Dr Stratton notes that the body conserves proteins it does not immediately need and if titres are elevated, the body is dealing with chronic exposure to Cpn from persistent infection.
Q. What is brain fog?
A. Brain fog is what we call the feeling of not being able to understand quite what is going on, losing the ability to concentrate, making rational decisions, answering questions, making choices. Many patients report this feeling before beginning the treatment, describing themselves as feeling stupid or having lost their ability to remember things. Luckily this is one of the first things to recover once you have started the antibiotic protocol, although at times you may find that it comes back to haunt you for short periods of time, especially when pulsing the Flagyl. Give yourself time, be patient and know that this will get better.