Is clarithromycin (Biaxin, Klacid) the best macrolide, and is combining it with hydroxychloroquine (Plaquenil) mandatory, in the treatment of Lyme-borreliosis?
I ask this because it appears to me that clarithromycin is currently the most used macrolide in the treatment of Lyme-borreliosis, and that it is often combined with hydroxychloroquine. I guess it has to be for good reasons.
Furthermore, does alternating the macrolide & hydroxychloroquine with a tetracycline class of drug improve the effectiveness of the treatment? If so, which tetracycline class of drug is thought to be best, and why? What are the typical dosages of the drugs used?
What is the average duration of such a protocol to reach a state of remission and/or eradication of all the spirochaetes?
Posted by CaliforniaLyme (Member # 7136) on :
Oh, let me get those answers for you*)!!!!!!
Brb in an hour or two*)*)! (Or not*)!!!!!!!!!
Posted by Rianna (Member # 11038) on :
Dr B Mentions this in his work
It has been suggested that when Bb is within a cell, it is held within a vacuole and bathed in fluid of low pH, and this acidity may inactivate azithromycin and clarithromycin. Therefore, they are administered concurrently with hydroxychloroquine or amantadine, which raise vacuolar pH, rendering these antibiotics more effective.
KETEK (Telithromycin), on the other hand, is stable in the intracellular acid environment, which may be why this is currently by far the most effective drug of this class, and may replace the others in the majority of patients with LB. Likewise, there is no need to co-administer amantadine or hydroxychloroquine. This antibiotic has other advantages- it has been engineered to prevent drug resistance, has almost no negative impact on E.coli in the intestinal tract (hopefully minimizing the risk for diarrhea), and it can be taken with or without food.
Macrolides/Cyclines treat the Intracellular/CWD Form
Cephlasporins and Penicillin treat the Motile form
Tinidazole/Flagyl Treat The Cyst form
Therefore is it necessary to take 2 different classes together.
Hope that helps Riann
Posted by mtnwoman (Member # 8385) on :
quote: it has been engineered to prevent drug resistance, has almost no negative impact on E.coli in the intestinal tract
Really? didn't know this....Any links?
It is my favorite med for lyme, personally.
thanks--
Posted by nan (Member # 63) on :
Rianna gave you the reason we take the two together....great explanation!
I know everyone reacts to meds differently, and Biaxin has been the best drug for me. I take 2 in the morning and 2 Septra in the evening, along with the Plaquenil.
Ketek, on the other hand, did nothing for me and has been implicated with rare heart attacks. Since lyme has affected my heart I stay away from this one. I do have a friend who was giving it to her young son for lyme and he did very well with it. Dr. J. was his doctor.
Posted by CaliforniaLyme (Member # 7136) on :
1: Clin Immunol. 2004 Dec;113(3):270-7. Links
Minocycline inhibits antigen processing for presentation to human T cells: additive inhibition with chloroquine at therapeutic concentrations.
Kalish RS, Koujak S. Department of Dermatology, State University of New York at Stony Brook, Stony Brook, NY 11794-8165, USA. [email protected]
The ability of minocycline to inhibit processing of tetanus toxoid (TT) for presentation to human T cells was tested. Peripheral blood antigen presenting cells (APC) were incubated with TT before or after addition of test compounds for 4 h. APC were then fixed with paraformaldehyde, and added to autologous TT-responsive T cell lines for a proliferation assay. Minocycline (0.1-0.4 mM) gave significant inhibition of T cell response to TT and was equivalent to chloroquine.
Inhibition was not observed when TT was incubated with APC before minocycline, indicating that presentation of preprocessed antigen was not inhibited.
Minocycline, doxycycline, and tetracycline all inhibited the proliferation of PBMC to TT.
The combination of minocycline and chloroquine resulted in additive inhibition at clinically relevant levels of both drugs (3.7 microM).
This study suggests a novel immunosuppressive mechanism for minocycline, as well as possible additive anti-inflammatory effect when combined with chloroquine or hydroxychloroquine.
PMID: 15507392
Posted by CaliforniaLyme (Member # 7136) on :
1: Med Sci Monit. 2003 Nov;9(11):PI136-42. Links
Macrolide therapy of chronic Lyme Disease.
Donta ST. Boston University Medical Center, 650 Albany Street-8th Floor, Boston, MA 02118, U.S.A. [email protected]
BACKGROUND: Macrolide antibiotics are highly active in vitro against B.burgdorferi, but have limited efficacy in the treatment of patients with Lyme Disease. As macrolides are less active at a low pH, their poor clinical activity might be due to localization of borrelia to an acidic endosome, and their activity improved by alkalinization of that compartment with hydroxychloroquine. MATERIAL/METHODS: 235 patients with a multi-symptom complex typical of chronic Lyme disease, ie fatigue, musculoskeletal pain, and neurocognitive dysfunction and with serologic reactivity against B.burgdorferi were treated with a macrolide antibiotic (eg clarithromycin) and hydroxychloroquine.
RESULTS: Eighty % of patients had self-reported improvement of 50% or more at the end of 3 months. After 2 months of treatment, 20% of patients felt markedly improved (75-100% of normal); after 3 months of treatment, 45% were markedly improved. Improvement frequently did not begin until after several weeks of therapy. There were no differences among the three macrolide antibiotics used. Patients who had been on hydroxychloroquine or macrolide antibiotic alone had experienced little or no improvement. Compared to patients ill for less than 3 years, the onset of improvement was slower, and the failure rate higher in patients who were ill for longer time periods.
CONCLUSIONS: These results support the hypothesis that the Lyme borrelia reside in an acidic endosome and that the use of a lysosomotropic agent augments the clinical activity of macrolide antibiotics in the treatment of patients with chronic Lyme Disease.
In contrast, the efficacy of tetracycline in such patients is not affected by hydroxychloroquine.
PMID: 14586290
Posted by CaliforniaLyme (Member # 7136) on :
I'd say 3 months!!!!!!!!!!!
Posted by Boomerang (Member # 7979) on :
What class of drug is Primaxin? I googled, but didn't get a definite answer.
Thanks!
Posted by jasonsmith (Member # 10914) on :
quote:Originally posted by CaliforniaLyme: 1: Med Sci Monit. 2003 Nov;9(11):PI136-42. Links
Macrolide therapy of chronic Lyme Disease.
Donta ST. Boston University Medical Center, 650 Albany Street-8th Floor, Boston, MA 02118, U.S.A. [email protected]
BACKGROUND: Macrolide antibiotics are highly active in vitro against B.burgdorferi, but have limited efficacy in the treatment of patients with Lyme Disease. As macrolides are less active at a low pH, their poor clinical activity might be due to localization of borrelia to an acidic endosome, and their activity improved by alkalinization of that compartment with hydroxychloroquine. MATERIAL/METHODS: 235 patients with a multi-symptom complex typical of chronic Lyme disease, ie fatigue, musculoskeletal pain, and neurocognitive dysfunction and with serologic reactivity against B.burgdorferi were treated with a macrolide antibiotic (eg clarithromycin) and hydroxychloroquine.
RESULTS: Eighty % of patients had self-reported improvement of 50% or more at the end of 3 months. After 2 months of treatment, 20% of patients felt markedly improved (75-100% of normal); after 3 months of treatment, 45% were markedly improved. Improvement frequently did not begin until after several weeks of therapy. There were no differences among the three macrolide antibiotics used. Patients who had been on hydroxychloroquine or macrolide antibiotic alone had experienced little or no improvement. Compared to patients ill for less than 3 years, the onset of improvement was slower, and the failure rate higher in patients who were ill for longer time periods.
CONCLUSIONS: These results support the hypothesis that the Lyme borrelia reside in an acidic endosome and that the use of a lysosomotropic agent augments the clinical activity of macrolide antibiotics in the treatment of patients with chronic Lyme Disease.
In contrast, the efficacy of tetracycline in such patients is not affected by hydroxychloroquine.
PMID: 14586290
So, what combo meds does this study suggest?
Posted by Rianna (Member # 11038) on :
I personally hink you should rotate all classes changing every 16 weeks as Brorson and MAB sugests, you then cover everything:-
So 2 weeks Penicillin/Cephlasporin for Motiles then stop and start
2 weeks Macrolide (if not Ketek add lysosomotropic) or Doxy for CWD then stop and add
2 weeks Flagyl/Tinidazole for cysts and hen stop for a 2 week break and then start again
I am on Bicillin/Ketek/Tini at the moment and a lot here in the UK do
Jason, it is not being preferential about macrolides but just recommending whichever one be paired with hydroxychloroquine!!!!!!!!! Because it potentiates it (wrong word?) it maximizes the efficacy- that was posted as to the WHY of pairing with hydroxychloroquine!! Best wishes, Sarah