27 Apr 2018

Zith is bacteriocidal?


Hi Paul, ...anyone else who wants to chime in,Paul, I read your post to Michelle about zith being bacteriocidal at the 250 dose every other day. I was under the impression that on this protocol zith is not taken to be bacteriocidal, but to eliminate the possibility of resistance of the cpn to doxy alone.


Lexy, the recommended dose is M/W/F and the main reason for taking it in these regimes is its synergic effect with doxycycline.  You are correct in what you say here:

"I know there have been discussions about the zith causing enough disruption to kill some cpn, however, I did not think it was truly significant."

It is slightly bactericidal but if it was that effective, flagyl would not be needed.  I take roxithromycin in place of azithromycin, but that has to be taken every day.  From mine and other people's experience it is probably more immunomodulatory, but can't be prescribed in the US.  It is difficult to get here as well, because although GPs are allowed to prescribe it, it isn't on the national lists so many don't like to.


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.

My doctor asked me many times, why ofloxacin is not used in this protocol, when it is bacteriocidal instead of doxy or azithro, which is only bacteriostatic. I said I do not know exactly and only repeated what Jim said to me: that dr. Stratton found out cpn developed resistance on ofloxacin more quickly. But I would be wonder if there is some other reason also, because I hear this question again and again. I continue strictly according to D_W protocol despite my doctor thinks ofloxacin is better, but it would be certainly very worthful for me to know some more arguments why not ofloxacin in this case. If some cpn gods are still listening, I would be very grateful.

Stratton/Wheldon protocol 02/2006 - 10/11 for CFS and many problems 30 years

 Lexy- Please tell Jim that this Jim also had strong reactions to the zith for quite a while each time I took it. Took me months to stop feeling reactions to it, and for the first months I was actually taking it every day due to a misunderstanding! It's hard to tell if it's the Zith alone or the synergistic effect with doxy that creates the bacteriacidal effect.

Part of it (Lala, this may answer some for you) is that, due to the relatively short life cycle of the bacteria, if it is inhibited from replicating but does not become cryptic, it simply dies. So more inhibition of replication may make for a bit more natural bacterial apoptosis.I would wonder if there was some potential for short course of this to get the load down, then switch to the regular agents, but every time we have seen someone try to shortcut the process they have been slammed by die-off reactions.

Another thing about zith, it isn't metabolized by the P450 enzyme system in the liver, so puts less stress on this organ, often stressed or itself infected (via Schwan cells, the liver immune cells). So it's a good addition. You'd have to ask David or Chuck Stratton more about theofloxacin.

On CAP's protocol for Cpn in CFS/FMS since December 2004.
Currently: 150mg INH, Doxy/Zith, Tini pulses 

"I really didn't say everything I said." Yogi Berra

Hi Lexy,

Zithromax is bacteriocidal or bacteriostatic against Cpn depending upon concentration. I think M/W/F is fine for dosing it but I do not think once every 4 days as Michelle was doing is a great idea. It may be the only possibility though so I should not pass judgement on this really. Also as it turns out Zithro is very effective against the peristent phase of Cpn but not particularly effective against the replicating phase. I do not know why but would guess it is because in the replicating phase Cpn has enough energy available to pump the drug out before it kills it. This in itself is probably bacteriostatic as it is using its resources for pumping and not replicating.

Regarding the question on Floxin (or other flouroquinolones), it has some pretty good efficacy against Cpn. I tried it for some time years ago and it did a good job of knocking out some Cpn. But it seems to stop working as well over time. This has historically been attributed to Cpn developing resistance to it. (Not sure this is exactly the case but it is close enough to not argue the point.) I would argue that it would be very reasonable to try a flouroquinolone as a replacement for Flagyl. They may provide as much or more benefit with less side effects. And if they stop being effective you can always switch back to Flagyl. I am not planning on trying this though and you shouldalways consult with your doctor, etc. before playing with drugs.

- Paul

I think there is an awful lot of hypothesizing going on here, I think that's great and this board is certainly the place for it, but they should be clearly labeled as such.

I would like to see a reference that supports the idea that flouroquinolones could be used in lieu of Flagyl. This isn't in the Vanderbilt patent to my knowledge and I have asked some experts about these antibiotics, specifically, and the (several) answers I received did not mention that these drugs could replace Flagyl.

I had just began the regimen and was on Rifampin/Doxycycline/Amoxicillin/Flagyl pulses when I developed a re-occurence of prostatitis, much more intense than what I had previously had. The urologist added Levaquin to my regimen, which I took for 12 weeks. It had significant effects= although the reactions were pretty different from the Flagyl reactions.

However, if Levaquin=Flagyl, I would go get some Levaquin, because I could see taking that daily for 6 months to a year, easily, while continuous Flagyl is much more dangerous, at least to me personally. But I'm pretty skeptical that they are equivalent.

But we're dealing with imperfect information that is continually evolving, so if there is a scientific citation that supports the idea that Levaquin could be substituted for Flagyl, please, let's see it...or other information that would support this point of view- this would be very useful information, if verified.

(Levaquin is $10 a day, is another issue...)

 Hi Paul- Could you give the references for the bacteriostatic vs cidal effects of zith, and it's effect on cryptic phase? I know Dr. Stratton has referred to the latter, but don't have the reference.

On CAP's protocol for Cpn in CFS/FMS since December 2004.
Currently: 150mg INH, Doxy/Zith, Tini pulses 

"I really didn't say everything I said." Yogi Berra

Very interesting information from all of you.

I took ofloxacin for 37 days and it certainly did more work in some areas than combination doxy/azithro/metronidazole in 9 weeks. But of course I can not know to which form of cpn it is effective. If I can compare it to doxy and azithro- I had lots of sharp pain throughout my body, which quickly came and quickly left, then I felt great relief in these parts. I have never felt such sharpness on azithro/doxy,  but I cannot compare to metronidazole, as I took metronidazole only for last four days and felt no reaction yet.

I am not going to do any experiment with fluoroquinolones into the protocol, my priority is to treat myself forever and not to try everything which goes around. But fluoroquinolones must have been very potent.

Also one more thing should be mentioned-Ines (cpnuser) wrote me fluoroquinolones are pretty neurotoxic and due to this fact they should not be used for prolonged time. I will ask my doctor for her source of information about ofloxacin..she treats tuberculosis succesfully with it.

Stratton/Wheldon protocol 02/2006 - 10/11 for CFS and many problems 30 years

To a certain extent the circumstances dictated the frequency at which Ella has taken the Azithromycin .   Initially she followed the MWF schedule but then having to be admitted to hospital with breathing difficulties and being unable to handle her medication herself (her hands did not work) we had to abandon it for a few days.  Doxycycline was easier to continue because she would take that with her supplements which I prepared for her.   

When she started taking the Azithromycin again after I was able to give it to her, she found that i brought on her breathing difficulties again.   Very frightening... However rather than stop taking them we spaced the dose out.   Gradually her reaction has become less and we are now aiming to take them MWF from next week onwards.   Michele

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

Michele, I don't know if it's parallel at all, since I have CFS, not MS, but I associate breathing difficulties with endotoxin/porphria. I've heard them explained as low or damaged hemoglobin, but they don't seem to be associated with physical effort. Oddly,  when mine go, they go very suddenly. I'll have the sensation that, "Oh, that's passed" and then won't be troubled with them at all for a while.

All: Speculating from my own experience, I would say zith is bactericidal, since I experienced distinct 'die - off' effects from zith that I didn't get from doxy at all. Just stopping reproduction shouldn't cause that, should it?


On Stratton protocol for CFS starting 01/06 (NE Ohio, USA).

RonOn CAP for CFS starting 01/06 (NE Ohio, USA)Began rifampin trial 1/14/09Currently: on intermittent

Ron, From my short, once removed experience, I would have to agree with you.   Not being a scientist I don't really know what is going on, but judging by the effects and the timing I would say there was a distinct reaction to Azi wheras with Doxy if there is a reaction it is much more subdued.   Michele

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

Paron, I cannot go there trought your link, but I see what you mean. Revelation to me, maybe obvious to you forum.

Stratton/Wheldon protocol 02/2006 - 10/11 for CFS and many problems 30 years

Daunted, Sorry it took so long to to dig these up. I really need to get a better system for organizing information. Generally the quinolones appear to work as well or better than other drugs but resistance does seem to develop so if you were to use them I think the strategy of using them for a few courses and then switching back to Flagyl seems like the best bet. I am not suggesting people run out and switch but it would be an option that you could consider.

Jim, Both of the papers have information of Zithro's MICs and MBC's against Chlamydia. The fascinating thing to me is seeing how effective Zithro is against persistent Cpn. While this paper suggests that the rationale for Zithro and Doxy might be reversed from what was previously thought, it also reinforces that they are the right drugs to cover RB and CP phases. Of course you have to assume that Trachomatis is effected in the same way as Pneumonia but that is not much of a stretch.

Activity of gemifloxin and other new quinolones against Chlamydia pneumonia; a review

[Journal of Antimicrobrial Chemotherapy (2000) 45, Suppl. S1, 35-39]

Azithromycin 0.05-0.25
Ofloxacin 0.5-2
Levafloxacin 0.25-1
Chlarithromycin 0.004-0.03

MBC (90%)
Levafloxacin 0.5-1

Bactericidal Activity of First-Choice Antibiotics against Gamma Interferon-Induced Persistent Infection of Human Epithelial Cells by Chlamydia trachomatis

[ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, May 2005, p. 1787–1793 Vol. 49, No. 5
0066-4804/05/$08.000 doi:10.1128/AAC.49.5.1787–1793.2005]

Doxycycline was superior in eradicating acute (minimal bactericidal concentration MBC100 = 2.5 to 5.0 g/ml) compared to persistent (MBC100 = 10 to 50 g/ml) infection. In contrast, azithromycin was significantly more effective in eradicating persistent infection (MBC100 = 2.5 to 5.0 g/ml) than acute infection (MBC100 = 10 to 50 g/ml).