I'm being treated (for babs) by a very non-LL NP, who somewhat reluctantly agreed to a phone consult with an LLMD (with whom I have an appt in 5 weeks). Per LLMD's instructions, my NP Rx'd a heavy duty regimen for 5 days (Mepron, Ketek, Flagyl, Mino, and another, whose name escapes me at this moment). After the initial 5 days, my NP instructed me to continue only the Mepron.

Since monotherapy with Mepron is unusual, I've verified this with my NP several times (even referencing Dr B's guidelines directly), and NP asserts that Mepron alone is all that is needed, as I took so many other meds initially (with 3 mos of doxy prior). This is despite disagreement from another non-LLMD in her office.

I've been on Mepron alone, with misgivings, for a month. Has anyone else been Rx'd Mepron alone? I am concerned about resistance.

Would stopping the Mepron until I can verify with the LLMD in 5 weeks create more chance of developing resistance?

On top of that, this particular NP tells me that I can't have Lyme, because of a negative Quest WB, and in spite of a positive PCR! (I thought a positive PCR was significant?)

I've already switched NPs, but the LLMD is out on vacation now, so until the new NP can verify treatment with LLMD in a few weeks, I need to make the choice to continue or discontinue the Mepron.

Any input on this would be appreciated. Thanks!

sounds like you are uncomfortable with your current LLMD situation and need to get treated by someone you trust.

If you do not like this NP then by all means get yourself to someone you feel you can trust. It makes a big difference in how you feel about treatment.

We have always taken mepron and abx together, treating two different creatures was my understanding.

A positive PCR means you have the DNA for lyme in your blood. You have to have lyme. Our bodies don't make antiboodies (WB) all the time. The positive bands on a WB are more significant than the number.

I tested positive on ELISA and PCR but only the bands specific to lyme on a WB. I have lyme.

Is an NP a duck?

Mel

(Note to Betsy: mepron not done IV, usually as liquid or pill. The pill is a lower dose of mepron, and is called malarone.)

I read A LOT about resistance. Two LLMDs told me I could stop completely b/c I hadnt been treating for very long.

You really should NOT use mepron alone. It is proven to cause resistance. this comes from e-medicine paper: http://www.emedicine.com/med/topic195.htm

Atovaquone (Mepron) plus azithromycin (Zithromax) -- Preferred regimens for severe babesiosis. Atovaquone should not be used alone. Resistance may develop; always use in conjunction with another anti-Babesia agent, preferably azithromycin.

I wouldnt risk it. But I am NOT a doc. Some docs will do a phone consult and maybe help you with this terrible decision. I know of one that might do this. It will cost $150 buks for 1/2 hour, but it was the second opinion I needed to know that I wasnt doing long term damage. E-mail me if this is something you want to do.

Here is another website I found but their links arent working! http://home.pon.net/caat/lyme/coinfections1.htm

Good luck,
Trails

You can take Mepron alone, without a macrolide. The studies that show Mepron resistance were done mostly on animals. The one human study that I know of had very few patients in it. However, the ILADS Guidelines suggests taking a macrolide with Mepron, based on the few studies where 20% of those using Mepron alone developed resistance. This is still being studied and is not 100% conclusive that a macrolide is necessary.

I take Mepron without a Macrolide because I have a terrible time with oral abx. I know the Mepron is working (sans macrolide) because I do get a herxheimer reaction from it. I did take Mepron with Zithromax for many, many months. I went off both in April (due to severe gastrointestinal problems from Zith) and the Babs came back in June.

I now take Mepron and Bicillin. I do not take any breaks on the Mepron. My MD is LL and has read all the papers on Mepron. He believes that it can work alone for some patients but, he does not think pulsing it is a good idea. That is just one MD's opinion. There are many opinions about this.

Hang in there. Find a LL Dr., if only just for a second opinion. I recently got a second (well, a fourth) opinion from a supposed Lyme expert (LLMD) who told me I don't have Lyme or Babesiosis, despite my positive blood tests and clinical symptoms. Go figure. These MDs, LL or not, are not omnipotent and are not always on the same page about diagnosis and treatment. I am a tad concerned that an LLMD was able to suggest such a strong Rx combo via a phone consult with your NP, without seeing or speaking to you.

Hope your appointment offers some answers to your concerns.