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 [PubMed - indexed for MEDLINE]
Posts: 3905 | From USA | Registered: May 2007
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Hoosiers51
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Just to translate for people, Hydroxychloroquine is Plaquenil, and a macrolide is Zithromax or Biaxin, among others.
Posts: 4590 | From Midwest | Registered: Jun 2008
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I have a question. What do you do when you cannot tolerate the plaquenil anymore? I've been on biaxin and plaquenil 2x day for a month. And Minocycline 400mg a day.
Do you back off the plaquenil completely if you get such bad side effects... or start with 1 a day instead of 2?
Is the biaxin a total waste if not used in conjunction with plaquenil?
I've read so many people who cannot tolerate plaquenil.
Also, what makes it a cyst buster? I've never read any med info that suggests this.
Thank you
Posts: 348 | From maryland | Registered: Jul 2008
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merrygirl
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To answer your question about Plaquenil it is a drug which changes the pH inside cells to be less acid, allowing the erythromycin-type antibiotics to be effective
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Hoosiers51
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I have been having problems with Plaquenil too Mandy. What is it doing to you that is bothersome?
I only take one a day....so i don't know if i CAN reduce it. For you, I would think maybe you could go to one a day instead of two, but ask your doc.
Posts: 4590 | From Midwest | Registered: Jun 2008
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I'm really slow tonight. I still don't understand what this all means?
I had to stop Hydroxy because it caused Pancreatitus and that was after five years.
Now I have switched to Azithromycin and Amantadine so is that a good replacement or should I go to Tetracycline or is the Tet no good.
Man, while you're at it can you tell me is I'm coming or going?
Steve
Posts: 406 | From Rhode Island | Registered: May 2007
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Hoosiers51
Frequent Contributor (1K+ posts)
Member # 15759
posted
Steve,
If you can't take Plaquenil (hydroxy....), you can't take it. I don't know if anything else would replicate those results.
I am not familiar with Amantadine and what it does.
The article is saying the Tetracycline is not made better or worse by Plaquenil......just that macrolides like Zithro are. So people shouldn't assume Plaquenil will make all antibiotics work better, just the macrolides.
Hope that helps or makes sense. I thought this was a cool study, but Plaquenil can be rough on a lot of people, it seems......so too bad
I am not sure if I am gonna keep taking it or not. It is causing lots of muscle weakness for me that I think is a side effect. I read somewhere that that side effect is considered something "severe" where you should stop taking it. Bleh.
Posts: 4590 | From Midwest | Registered: Jun 2008
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posted
Hoosiers- The plaquenil is just making me feel like total crap! Today was the first day I didn't take it and I feel alot better, but if the biaxin by itself is useless I guess I'll add it in 1 x a day. What are your symptoms?
I'm herxing hard, feel very neurotoxic or something, but wonder if it is bad side effects. My fingers, toes and knees get achy. Glands swollen. Upset stomach of course. I have to take high doses of Vit C to go to bathroom. Muscle weakness, severe brain fog, yellow looking skin. If people have had success with this one, I guess I can tough it out another 2 months. Just not sure when enough is enough.
Steve- Along with this biaxin and plaquenil combo I am taking 400mg minocycline. At first it gave me vertigo but now I have adjusted and like this one. This would be a good alternative to what you were taking and I've heard it is better than doxy but I'm not sure why.
Amantadine and Azithromycin is a good combo I just looked it up in Dr. B's guidelines. Apparently, like Plaquenil the Amantadine acts in conjunction with the macrolides.
Posts: 348 | From maryland | Registered: Jul 2008
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I'll have to ckeck around but I know it's a done deal on no more Plaq as I had very painful Pancreatitus and my Liver enzmes went waaay up so my Gastro said no more Plaq and my LLMD agreed.
Mandy
I have the Minocyline too but had to pull back on that one for a while till the liver quieted down which it did and I can start again anytime I want but will wait till we get back from vaca in New Hampshire in October.
Steve
Posts: 406 | From Rhode Island | Registered: May 2007
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Maybe you should switch too? I don't want to scare anyone off Plaq but if you ever had the Pancreatitus thing? Well...I hope no one gets it, man it was the wost pain in my life!
Steve
Posts: 406 | From Rhode Island | Registered: May 2007
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Hoosiers51
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posted
Mandy,
How long have you been on the Plaquenil?
I have been on it 6 weeks. A lot of the creepy symptoms I got, like really bad weakness in fingers and hands, would get better slowly, but it is still there, which is what freaks me out.
I am thinking I shouldn't be taking it.
I saw something today that listed the side effects from Plaquenil, and next to each one it put "severe" or "less severe".....and for muscle weakness it said severe, which led me to believe it is a reason to discontinue. But I haven't made that decision yet.
I also have had constipation, didn't think that it could be from Plaquenil. My main problems are muscle weakness.
Posts: 4590 | From Midwest | Registered: Jun 2008
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posted
No, never had any major side effects from the abx but I haven't been on them that long. They destroy your insides I know that.That sucks I'm sorry. Is this pancreatitus something that can be fixed/healed? Will the abx interfere with this? Yeah, maybe I will try the amantadine. This plaquenil is harsh. It's making me a demon .
Have fun on your vacation, take a break from the torture!
Posts: 348 | From maryland | Registered: Jul 2008
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I haven't made the decision to stop either. Sounds like we are having similar side effects. I've heard it's generally tolerable. This study looks promising if we can suffer through it for 3 months. I'm gonna take one a day I think for now and see how it goes. I weigh 100 lbs so I suspect the dosage is just too high.
Posts: 348 | From maryland | Registered: Jul 2008
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Lymeorsomething
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posted
Plaq's not for everyone. I had sides within the first few days including eye strain, bleeding gums, and tinnitus....
-------------------- "Whatever can go wrong will go wrong." Posts: 2062 | From CT | Registered: Jul 2008
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I have been off the Plaq for about a year now and no more Pancreatitus but I'm not taking any chances.
You guys are just starting out on Plaq, I took it for over five years straight and I can tell you it makes you feel terrible but if it has any chance at all of working for you? Keep taking it. If you start to have bad stomach aches, back off for a few days,if you still have the stomach ache talk to your LLMD about it.
It's juts one of the known meds that cause Pancreatitus and from what I read no one really knows the exact details but I read some very scary things about it.
When I was at the ER first the Doc there said nothing to worry about and we are going to give you Dilaudid for the pain, then when I'm high as a kite I hear him tell the nurse to call the Surgeon in for me! Yiiiiuikes!!!! Yeah that got my head straight pretty quick.
Steve
Posts: 406 | From Rhode Island | Registered: May 2007
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David95928
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posted
Quite a few folks, myself included, have done well on a combination of Biaxin and Bicillin LA
-------------------- Dave Posts: 2034 | From CA | Registered: Jan 2003
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Hoosiers51
Frequent Contributor (1K+ posts)
Member # 15759
posted
Mandy, anyone weighing less than either 120 or 130 (can't remember which) should only be taking 200 mg per day of Plaquenil.
Posts: 4590 | From Midwest | Registered: Jun 2008
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i can't take hidroxycloroquine, i feel ill fastly, but i can take cloroquine instead very well;
the french articles that discover this, rise of ph of acidic vacuoles against intracelular bacteries, they used cloroquine, have the same efect in this fact;
i can't believe the theory of living in acid vacuoles, borrelia is a giant bacteria, i think cloroquina is killing the cyst
best, ant
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