Posted in Flagyl on March 3, 2017


I wish talk a little about treatment approaches.


No individual knows the best way to delight chronic Lyme disease; and what works most wise for one patient may not drudge well for another.  In a consciousness, each patient is his/her own “experiment.”

Treatment of of long duration Lyme (and associated infections) is based forward:  A new paradigm regarding the role of tickborne infections and its kindred to chronic illness. Scientific information; hypothetical evidence from the collective experience of a liberal cohort of physicians over many years; the clinical ingenuity of the treating physician; and, resembling models which can be drawn from Mainstream Medicine embody the basis for treatment.

Tuberculosis ~ward one level offers clues as to the superintendence of chronic Lyme disease.  Lyme and TB one as well as the other bacterial illnesses which are difficult to behave to due to the presence of Persister organisms.  Experience by TB may offer clues as to by what mode best treat Lyme, and  — offer proof of concept regarding the “cocktail” advance used to treat Lyme.

Lyme persisters are notion to largely be comprised of frank body forms and biofilms colonies. Let’s redress the record.  No L-forms be the subject of been found.   The Lyme spirochete is pleomorphic. This substance it can change its form.  Bacteria vouchsafe not form cysts. Round forms of the spirochete may have existence referred to as pleomorphic variants or circular dance body forms.

Antipersister drugs:  Persisters and their appropriate therapy is mystical.  The drug pyrazinamide (Z/Pza) is a key dividend of the therapy for tuberculosis. The medicine was discovered in the 1920s and at the outset used for TB in the at daybreak 1950s. It is an essential, in a high degree. effective antipersister drug for TB.

With today’s learning the drug would never have been discovered.  The physic was not initially tested in a exhibition tube (in-vitro). The drug was earliest test in a mouse model (in-vivo) and was found to be highly effective.  The physic has no activity whatsoever in a ordeal tube. The modern scientific approach would be delivered of screened out and discarded the put ~s into forever.

Initial therapy for TB consists of 4 drugs given into junction in a “cocktail.”  There are numerous other examples of bacteria which are treated with combination therapy, for example H. pylori, further TB provides a good template.  TB virus may be systemic, but is commonly limited to a single organ – the lung.

Late omnibus Lyme is always disseminated, infecting divers organs. TB is generally treated in the place of 6 months. It makes sense that Lyme may want long term as well.

In trial tube experiments Zhang found eradication of Lyme bacteria required a cocktail of three efficient antibiotics.  This is also provides testimony of concept.


I typically negotiate Lyme with a cocktail of 3 drugs, as tolerated.  Choices are based forward the answers to certain questions:  Has the mix with ~s been shown to have good sprightliness against the organism, even at servile serum concentrations?  Does the remedy offer synergy when combined with others? Does the drug have good tissue penetration and be able to it pass through the blood brain obstruction (BBB)?  Does the drug likewise hit coinfections? How will that press close together choices?  Does the proposed “cocktail carry off spirochetes and persisters well? Are mix with ~s to drug interactions a concern? Should the drug be given by mouth or through IV, or even IM?  Are side effects tolerable?  On balance, translate the benefits outweigh the risks?


Doxycycline: to the end of time first line –  most effective in compensation for spirochete form of Borrelia organisms, usually well tolerated; may be given by mouth or IV –  one or the other way, good systemic adsorption and profit penetration into brain. Kills Lyme more fit than minocycline. Draw back:  none effect on persister forms. That’s OK. That’s for what cause we use a cocktail.  The subsidy of hitting coinfections cannot be understated.

Second remedy choice(s) Rifampin is a pretty large choice. By a synergistic mechanical construction, confers antpersister properties to doxycycline; achieves obliging tissue and brain levels; it is an antipersister with a proven track history, used for TB and used to eradicate Strep bacteria vehicle.  Drawback:  Highly active to counter-poise Bartonella sp.  Herxheimer reactions have power to be intolerable.

Another choice could have ~ing Bactrim, effective only at higher doses, different doxycycline which can be effective at let down doses, also hits Bartonella sp. Herxheimer replication less drastic than that seen by Rifampin. Still can be a none starter. Kills persisters and penetrates BBB.

Another election could be Tindamax.  Well tolerated, pious blood and tissue levels and extremely active against Lyme organisms. Sapi’s investigation says it is excellent against persisters. Zhang’s examination says it is only slightly more appropriate than Flagyl (which he surprisingly erect has little or no activity in countervail to persisters.  All I can take for granted is it works.

Another option could have ~ing Amoxicillin or Ceftin.  I typically practice these drugs when doxycycline is not tolerated or not one option.  Amoxicillin does not bore the blood brain barrier unless given in prominent doses but may be an crack choice because of low toxicity and it is hightly lively against spirochete forms.  Ceftin is the singly oral cephalorsporin said to penetrate the BBB; It also shows mode of action against all forms of Lyme (spirochetes and persisters).  Not my primitive choice because it may be too hard on the gut and I it s again likely than others on this list to produce C. diff. Good option when tolerated.

The defeat offenders for C. diff are quinolones of that kind as Levaquin.  Drugs of this class have power to also cause tendon rupture. They perforate well into the brain but have power to cause odd brain side effects that are not Herxheimer responses. I counsel avoiding these drugs if possible and using shabby doses when necessary.

Biaxin and Zithromax may have existence good choices but are not usually primeval line.

Why use 3 drugs?  There is none scientific basis for this. Zhang’s ground of admission tube results are a weak question, at best.  I have used to use 2 agents in the past and wish found 3 works better.  I don’t use 4 because I worry concerning the increased risk of toxicity, and — 3 works.

There is none consensus on how best to gratification the disease.  This approach has evolved through the whole extent of years and may be quite dissimilar from recommendations seen elsewhere. In indefinite, treatment is long-term: The fulness of therapy  may be much greater amount of important than specific choices of therapy.  Again, what works for one patient may not toil well for another.   Coinfections destitution to be considered and may be changeable the clinician’s approach to the long-suffering dramatically, even at the start. The use of IV antibiotics or IM (penicillin) vs vocal agents needs to be sorted at a loss. There are many other drugs that may be considered, not discussed in the present state.  The duration of therapy is unpredictable and manifold for every patient.

Continuous therapy vs pulsed therapy is a intricate discussion, not covered here.

Drugs are not at any time started all at once. They are a little at a time added incrementally, watching for toxicity and/or verge effects.   


Federal interchange commission and 24 treatment attorneys not partial.

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