New here. I was just diagnosed last week - immense relief to have a solid answer for all the symptoms, thought I was slowly going insane! - and I have been prescribed a regime of oral cefpodoxime and metronidazole.

I'm curious about the dosage and regime my doc has prescribed. I live in the Hudson Valley - Dutchess County, epicenter of Lyme, hooray - and my doc has extensive Lyme experience & is an excellent workable guy, and he's always willing to tweak meds within reason.

Background: I'm a 40 year old woman with a 4-5 year history of Lyme symptoms following a cluelessly-ignored bullseye rash, & extensive ruling-out of other diagnoses. Recently the neurological symptoms have gotten worse & kinda scared me (numb hands, tremors, clumsiness, forgetfulness, extreme lassitude/fatigue, reversing letters when I write, loss of active vocabulary, ear-ringing, etc).

I'm to take the metronidazole 250mg and the cefpodoxime 100mg each twice daily (total 500mg and 200mg respectively), two days per week. (I'm quite allergic to the penicillin family/doxycycline, thus the alternatives.)

Is it typical to begin one's very first treatment with this pulse therapy? Or would a daily dose be preferable? According to my research, this appears to be a rather low mg dosage - is it? My pharmacist pointed it out as unusual, so I wanted to check in with folks who may have some experience with these meds for Lyme.

Thanks in advance for any tips or references,

Yes your dosage seems quite low - my guess is he could be watching out for allergies, or perhaps even trying to avoid toxin buildup and major herxing (since you've been infected but untreated for so long).

When you treat bacterial infection with antibiotics, the bacteria die-off releases toxins into your system. Toxins are removed by your liver. At some point, usually after week, 10 days , a month (everyone's different), the buildup becomes to great for your body to cope with, and
your symptoms all become magnified, and usually some fun new ones pop up (my favorite are the heart palpitations and itchy rash). This is a herx (aka Jarisch Herxheimer reaction).

Interesting that you say you're allergic to penicillin - is that verified, or have your perhaps had reactions since you've been gotten Lyme which were actually herxheimer reactions... just a thought..

Keep reading here - you'll learn lots.

It usually takes 4 days for the antibiotics to build up sufficient blood levels to kill the bacteria. If you only take it twice a week, you're never going to get there.

Is there a reason the doc didn't try Biaxin or Zithromax? These have a different mode of action, and combine well with Flagyl (metronidazole.) You might avoid the allergic stuff with those, either in addition to, or instead of the cefpodoxime.

Now, I will grant that some have a very hard time with antibiotics, above and beyond the herx reactions. Its not the rule, but if you had allergic reactions, you do have to be careful. However, there is the possibility that the allergic reactions were actually herxes.

You might want to consider getting a second opinion, either on your treatment, or your doctor. Maybe the doctor knows something we don't, and he's right. But if you post in the section Seeking a Doctor, somebody may know him and give feedback, or recommend someone else who might be better.

You have read the basics?

Dr. Joseph J. Burrascano's Treatment Guidelines

Treatment Summary

Hi and WELCOME! Get a LLMD or at least Dr that is willing to learn about lyme. Borrelia Burgdorferi is a clinical diagnosis, based on symptoms and on your response to treatment. Good Luck, bumpy road ahead.

Post for a LLMD in Seeking a Doctor. Ps remember I am not a Dr, just a fellow sufferer.

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No you don't always see a bite and if there's no bullseye the only way your going to be able to tell is (symptoms) and (((Maybe))) WB or lyme dot blot 3 day urine banged with abx's to free your antigens up for the test.
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I've been allergic to penicillin since I was an infant, so I doubt it's Lyme related, but good tip.

I'll talk to my doc & see what the rationale is for the pulse therapy & low dosage - he's Lyme-literate, so I suspect he'll have a good explanation, and if I really want to up the dose etc I bet he'll be OK with that. I was concerned after reading the Burrascano piece that it's too low a dose considering this is an advanced infection.

I'll keep reading & gettin' myself up to speed - thanks again!