Roxy/Bactrim Question

According to the recommendations of Prof.Gasser should Bactrim be taken 5-6h after intake of roxithromycin .
Anyone knows why, or can it be taken together?

Interesting, I didn't know that detail of the Gasser protocol.

 Both drugs have a half-life in the same range (10h), and peak plasma conc. at 1-2 for Roxi vs 2-4 for Bactrim. Roxi almost entirely binds to proteins, while the substances in Bactrim only partially does. Perhaps the explanation lies here, or in absorption (roxi to be taken well before meals, while Bactrim is easily absobed)? Only wild speculations.

 Are there other things to consider if adding Bactrim to a Wheldon CAP (with Plaq/Hydroxychloroquine in my case)? Now at day five of tini pulse my soles start burning a little (has been a lot better off tini); thinking tini perhaps causing a Babesia reactivation or "herx".

 There is also the question of dosage; Gasser used a 300mg bid  scheme for rox, and a similarly high (twice standard) dosage for Bactrim, if I recall correctly. Quite an increase/addition to a CAP.

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?

HI Nord ! The Roxy is instead of atzi and the bactrim replaces the tetracyclin. So you have 2 bacteristatic agents.


But I know for sure that you can take teracyclines like mino with Bactrim as well as Macrolides with Bactrim.


Jim K took the combo of Roxy/Bactrim.



THE LANCET, VOL. 336, (NOV 10, 1990) p. 1189f.

Oral treatment of late borreliosis with roxithromycin
                 plus co-trimoxazole
SIR, - Early, but not late, Lyme borreliosis has been successfully
treated with oral antibiotics such as penicillins, erythromycin, and
tetracycline. The possibility of an oral treatement is desirable,
especially in view of the great difficulties that arise with long-lasting
intravenous treatment in third-world countries.(1, 2)
Various workers have shown relapses and failure of treatment in late
Lyme borreliosis(adrodermatitits chronica atrophicans, arthritis,
neuroborreliosis) even with high doses of intravenous penicillin or
ceftriaxone. (2, 3)
Treatment that is both orally applicable and effective is certainly
needed.(2) Co-trimoxazole is a powerful antibiotic combination to
which many microorganisms respond, including the spirochaete
Treponema pallidum. Furthermore, it has been show that the new
macrolides(such as roxithromycin) show a remarkable antimicrobial
activity angaint B burgdorferi.(4,5)
It is noteworthy that the blood/brain barrier is highly permeable
to roxithromycin.
A 30-year-old man infected with B burgdorferi 7 years ago was
successfully treated with a combination of roxithromycin(300 mg
twice daily) and trimethoprim/sulphamethoxazole(320 mg/1600 mg
twice daily) after both intraveous penicillin(20 million IU
daily ober 3 weeks) and later ceftriaxone 2 g twice daily for 3 weeks)
had failed (figure {not included} ). Both intravenous penicillin
and ceftriaxone reduced the symptoms transiently, while IgG remained
However, shortly after a 3-week course of roxithromycin/co-trimoxazole
all symptoms disappeared and a recent assessment of IgG revealed a
negative titre. The recovery of the patient's neurological
disorders was strikingly rapid, possibly because of the high
permeability of the blood/brain barrier to roxithromycin. Thus,
albeit in only 1 patient, we have shown successful oral treatment of
late Lyme borreliosis with a combination of roxithromycin and

Robert Gasser, University Laboratory of Physiology, Osford OX1 3 PT, UK

Johann Dusleag, University Medical Clinic, Graz, Austria

1. Steere AC, Malawista SE, Newman J, Spieler PN, Bartenhagen HN.
Antibiotic therapy in Lyme disease. Ann Intern Med 1990;93:1-8.

2. Weber, K, Preac-Mursic V, Neubert V, et al. Antibiotic therapy
of early European Lyme borreliosis and acrodermatitis chronica
athrophicans. Ann NY Acad Sci 1988; 325-45

3.Dattwyler RJ, Halperin JJ, Volkman DJ, Luft BJ. Treatment of
later Lyme borreliosis - randomisesd comparison of ceftriaxone and
penicillin. Lancet 1988: i: 1191-94

4. Preac-Mursic V, Gross B, Suiss E, Wilske B, Schierz G. Comparative
antimicrobial activity of the new macrolides against Borrelia burgdorferi.
Eur J Clinical Microbiol Inf Dis 1989; 8: 651-53

5. Steere AC, Grodzicki RL, Kornblatt AN, et al. The spirochaetal
etiology of Lyme disease. N Engl J Med 1983; 308: 733-40.

[note from poster]
In response to this article a few weeks later there was an article from
two physicians of the University Hospital of Frederiksberg, Denmark
(Departement of Rheumatology and Clinical Microbiology) entitled
with: Late treatment of chronic Lyme arthritis.
They discussed a similar case and also tried this combination treatment
of Gasser and Dueslag.
They also were successful and came to the conclusion that,
"combined therapie with roxithromycin and co-trimoxazole may prove
effectiv in chronic Lyme arthritis where conventional antibiotics
have failed."

(THE LANCET, VOL. 337, JAN 26, 1991, page 241)

-----------------------… uids=7782115&dopt=Abstract

Male 38 years (Germany),CFIDS, IBS, Enterovirus, Cpn and Bartonella, Dientamoeba fragilis positive. Started Cap on 02/19/08, Currently taking Bactrim, Flagyl, soon adding Malarone and Clindamycin for suspected protozooa. 

Hello Cesare,

Thank you! Yes I see the basic idea, and the azi > roxi switch is basic Wheldon CAP (and I'm already on roxi), but is Bactrim effective against Cpn (to keep a double bacteriostatic pressure on Cpn)? Wnat to be certain keeping the pressure up. My question is perhaps then: is it ok with roxi 300mg bid+100 mino+2*Bactrim DS bid (1600 mg sulfamethoxazole and 320 mg trimethoprim bid), and pulsing tini 500mg bid?

I am awaiting artemisinin and green tea extract to arrive, and think that I should perhaps include either Bactrim or Atovaquone to see if there are any "Babesians" to stir up (probably). Thank you for reminding me of Jim's blog entry, had forgotten that I'd read it.

About your original  question: there isn't any rationale given where you found the sequencing, have you asked Gasser?


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?