Pulsed Antibiotics- The Future for Lyme Posted Oct 06 2009 10:02pm I am working with infectious disease specialist, Dr J (SC) and am excited to share his concept of "pulsed antibiotic therapy" and how he is treating me and hundreds of others, successfully, For the first time in over 1 1/2 years I feel I am getting my life back.
The 3 major players in chronic Lyme are Borrelia (Lyme), Babesia,and Bartonella. Sure we are also teaming with viruses, yeast, Mycoplasma, and other undesirables but he believes that if you can get the big 3 under control you can eventually get the immune system back into a functional state.
According to Dr J these 3 organisms are almost always present in chronic infections and fortunateley they divide slowly-which allows for dosing antibioitics every other day. He has been treating patients this way for the past 5 years with good results. He uses all antibiotics, orally or intravenously, on alternate days- typically M,W, and F.
I am currently doing Clindamycin 900 mg twice daily intravenously M,W,and F with Azithromycin 500mg, also intravenously. In addition I am doing 1000 mg Artemesinin and Mepron (2 tsp) orally twice daily on theses same days. After one week of this, he had me add in (oral)Bactrim DS, 1 1/2 tablets again M,W, F. I also add Flagyl 500 mg twice daily on Th and F (orally). These drugs are treating Babs, Bart and Lyme forms.
On the days when I am not infusing/taking antibiotics he has me infuse one liter of Lactated Ringer's solution which he feels helps buffer the body (help it be less acidic) and "flushes" the organs.
Every 2 weeks he has me take a full week off treatment to see how I am and this (he believes) allows the immune system an opportunity to regain strength. How you do on the week(s) off allows him to get a glimpse of how well the immune system is recovering. This is a technique he used for years in his HIV patients and I think it makes a lot of sense as a physician.
The key to this disease is not to eradicate every last evil bug- rather it is to get the infectious load down low enough so that our immune system can recover and take over its job. Antibiotics are great but if they are poisoning your livers, and suppressing your immune system they can be counter productive.
I believe the reason some of us do not recover is: the 3 big players are not addressed and the immune system is not brought back.
Regarding the first, it is great to test for co-infections but if negative these tests should NOT preclude treatment. All patients with chronic Lyme should be treated for ALL 3 big players (Bart, Babs, and all forms of Lyme). Demand treatment for all 3. Babesia is the hardest to eradicate ie long term Atemesinin is needed (I'll post more on this).
Regarding the second, the immune system should be supported as much as possible, ie transfer factor?, treating for yeast intemittently, taking breaks from antibiotics. If the immune system is not supported you will keep "chasing your tail."
Thus far, I feel the best I have since becoming ill summer 2008. The best part is that I can sort of get my life back- as I know which days I am infusing. He also has some novel ways to deal with herxing and detoxing (see my next post).
My hope is to get other doctors involved in clinical trials with his protocol. I am meeting with a doc next week here in Boston to see what can happen. If you have a doc that may be interested let me know. It would be great to get some other infectious disease docs involved.
It's time for us docs to stop fighting and start communicating and working together!
Posted by massman (Member # 18116) on :
Thanks !
Do you feel that pulsing non-abx like mixed or straight herbals would also be effective ?
Posted by seibertneurolyme (Member # 6416) on :
Even if the antibiotics are being pulsed 5 different antibiotics plus art are being used. Many people can't tolerate all of that at once. The doc still rates as one of the "blasting docs" in my book.
In theory it sounds good, but just not sure it is doable for the vast majority of Lymies.
I do agree that treating just 1 infection at a time doesn't work so well, but very few can handle treating all 3 at once.
Bea Seibert
Posted by springshowers (Member # 19863) on :
Note.. I also used to think this way Bea
Now that I have been on IV abx I see things and feel things in a totally new way.
Why? I have no idea?
But I can take high doses now and combos of various meds up to 3 to 5 at a time.
I WOULD NEVER Have been able to do that when I was doing orals as I have been trying to do for many years.
What gives?
I do not know.
So... I could do this protocol as stated above.
Two months ago. I would have said the same thing you did....
Its interesting to say the least.
Posted by canefan17 (Member # 22149) on :
Depending on how old you are, genetics, etc... can play a role.
I'm a 25 yr old male and I'm "blasting" with antibiotics and doing just fine with it.
I don't feel my immune system is being compromised.
Posted by beths (Member # 18864) on :
At 1 1/2 years int treatment, I started to feel like I was turning the corner...never know if it was the med timing or pulsing.
Posted by coltman (Member # 21272) on :
Hmm so ok for slow dividing bacteria it works. What about the fast dividing one - it seems like you might get uber resistant strains of e.coli and c.difficile this way
Though if you doing it IV its probably ok
Posted by IckyTicky (Member # 21466) on :
Sounds great to me. I don't know how anyone can afford allll those meds at the same time though. Especially for those like me where the whole family is infected.
Does it matter how many of those are used? Does IV have to be used?
Posted by seekhelp (Member # 15067) on :
Five drugs would knock me into oblivion I bet. Yes Bea, 'drug blaster' seems appropriate. Apparently he has magic detox suggestions according to the poster.
It sounds like your hubby certainly has taken a lot of drugs though so I guess it's not always the solution. Wouldn't treating all three at once only be super tough IF you have them all. He's just guessing anyways according to the poster and blanket treating.
I wonder what would happen if someone jumped in and took 20 gr of salt/C day one?
Posted by cantgiveupyet (Member # 8165) on :
coltman- good point. Does anyone who has used the pulsed protocol had resistant ecoli etc.
Also, Im wondering if Strep could be an issue with this pulsed method.
Anyone that has pulsed abx reached remission?
Posted by Amanda (Member # 14107) on :
You know, I tried this approach, and actually went downhill slowly, over time. The problem was that every time I would stop the abx for even 2 days, my symptoms would come roaring back (that was with treatment for co-infections).
But, I think its good to try this approach.
The biggest problem for lyme patients and our LLMDs is the cookie cutter approach that the IDSA created and has imposed on us. So, I don't think the solution to that is for the LLMDs to decide that one approach or another is the "best" way, that just another cookie cutter. The "best" appraoch is the one that works, and since we are all different, its important to be open to different options for different patients.
Posted by canefan17 (Member # 22149) on :
Amanda,
The problem most LLMD's have is that they have a method they feel is "the best" at this point.
It's very tough for them to just start experimenting with patients when they feel their proven methods work best.
LLMD's do a lot of great things and help cure a lot of people. At some point we have to trust that these guys know a little bit more than we do.
And sure they might fancy this particular LLMD's ideas... but until it is continually proven beneficial they will stick to their guns.
Posted by canefan17 (Member # 22149) on :
Amanda,
Are you sure your symptoms were coming roaring back or that you were herxing?
This seems to be big confusion for many patients (myself included)
How can one distinguish between a herx and the symptoms flaring back up.
Posted by springshowers (Member # 19863) on :
I am starting to do Ringers ... and hope it helps this way.. too
"On the days when I am not infusing/taking antibiotics he has me infuse one liter of Lactated Ringer's solution which he feels helps buffer the body (help it be less acidic) and "flushes" the organs."
Posted by txgirl09 (Member # 21612) on :
Amanda--I've just started to experience something similiar. And I don't know if my symptoms are worsening, or if its a herx while taking the 2 week break.
Posted by WildCondor (Member # 434) on :
The success or failure of pulse therapy depends on what medication is being used. Some can be pulsed and some are better taken every day. Flagyl and artemesia should be pulsed. Some other antibiotics might not fare as well when used this way.
Be very careful on that Clindamycin! it is the # 1 offender for c.diff which can destroy your colon and you will not be able to take Lyme antibiotics after that for a long while, if ever if it is bad enough. Make sure you take Florastor!
Posted by Erica741 (Member # 15186) on :
I just finished this exact treatment protocol (minus the Bactrim) and have made more progress so far with this doctor (now in 9th week of treatment) than in the entire year and half I'd been treating before.
I don't understand the resistence concerns. Using IV combos and changing them about every 4 weeks actually minimizes resistence issues.
Posted by springshowers (Member # 19863) on :
I think we could all learn alot from this protocol and method of treating. I am close to it and also add integrative treatments I believe in via iV.
Here is a link to all of this persons (who is an MD too) blogs and she reports each week how and what she is doing exactly and how the protocol is set up and what and how she is taking it all.
It is good to see someone track so specifically and to see that it is working for her and she is getting to see a good doctor too.
I really like the approach.
I am using some of this info to find tune.. my own protocol.
I am a bit conflicted on the pulsing of M W F or doing 3 days on and 4 days off..
I just can not decide... on that one.. yet..
Posted by coltman (Member # 21272) on :
quote: I don't understand the resistence concerns. Using IV combos and changing them about every 4 weeks actually minimizes resistence issues.
I dont know the exact protocol but here is how resistance develops - you apply a drug to a system, it doesnt kill all the bugs ,some of those survive. Those which survive replicate in the absence of a drug , next time you apply that drug more of them survive .
Factors which are important - inhibitory concentration of the drug in blood (e.g. the one which actually kills or prevent bacterial replication) , half life of the drug and time between doses.
So if you pulse high doses but allow intervals in between with no drug in system ,those bacteria which survive will replicate, and those one will be the one resistant.
With constant pressure on bacteria there is no time for it to replicate and immune system usually finishes the rest (or another combo drugs - having beneficial mutation happen to provide resistance to several drugs at one is much much lower probability than if you do one drug at a time) .In fact there is a study which shows resistance evolving to just tetracyclines or just macrolides of one bacteria , but not when both of them were used at same time.
With bacterial with long division cycles such as BB it is not as important - because mutation rate is low. But you have lots of other bacteria in the body with much faster replication and mutation rate.
Posted by coltman (Member # 21272) on :
quote: Here is a link to all of this persons (who is an MD too) blogs and she reports each week how and what she is doing exactly and how the protocol is set up and what and how she is taking it all.
Hmm where is ze link! Lost ? Posted by Hoosiers51 (Member # 15759) on :
Zithromax has a half life of 68 hours. So I don't understand how only taking 1 or 2 days off between doses is actually "pulsing."
Maybe the doctors that do this find it works in their experience, and that might be the case, but I'd be interested in the reasoning behind this, because I don't see how you would get any kind of pulse effect when the half life is that long.
Posted by Pinelady (Member # 18524) on :
Sounds great.
Don't be afraid to throw some vitamin E in there.
I am taking 600 and noticing a dramatic
improvement. So I am going to 800. I think it may
help prevent biofilm.
Posted by Amelia (Member # 17677) on :
I am trying to move this to the top as I feel
it is great information that may help many!
Thanks Dr. Phuli!
Posted by Hoosiers51 (Member # 15759) on :
Does anyone know why some doctors do Zithromax M-W-F, even though the half life is 68 hours? I was hoping someone knew. I don't see how that is any different than just taking 50% of the dose daily.
Posted by TF (Member # 14183) on :
Here is an update to this post from Oct. 2009. Thought some of you might be interested in how Dr. Phuli's pulsed treatment is going:
That's interesting. Thanks for the links. I have taken breaks in my treatment, and I always see more improvements when I start antibiotics up again. I think that the idea of getting your immune system to take over is great.
![[Smile]](smile.gif)