Question for Chapelle

Chapelle: I know you can't advise me on what to do with medications, just wondering what your opinion is.
I will, of course, talk to the ND about my plans.

Hi Georgia, I'm on 600 twice daily of Zithromax & as of today, also 500 twice a day of ceftin... You think this is too much?

Darn it, now I'm questioning my doctor...

I'm 5'6 and weigh 125 lbs. So of the only reason someone would need a dose like that is obesity... Then I don't understand why she would've chosen such a high dose.

What do you think is appropriate here, 600 a day Zithromax and 500 a day Ceftin?

I'm taking doxy 400mg/day and azithro 250mg/day (will be 500 soon). I'm also wondering why not take both at the same time? I take doxy for lyme, azithro for babesia. the bonus is that they each target other coinfections as well

If resistance developed to Doxy or Azithromycin, it would most likely be resistant to the other one and if taken together, that chance would increase. They work exactly the same way they just affect a different protein inside the cell.

Guys I can't give public opinions on your protocols, my opinion is not worth more than your physician. I can tell you that I've had Lyme twice and have not had any Lyme symptoms for several years. This Babesia or protozoan is tough but I can treat it until I have no symptoms. I don't want to do that, I want to kill it. That seems to be difficult.

^ directed at Georgia. I know cyst busters are a bit off topic, but I'm curious. And curious what you did overall since you're Lyme symptom free. Thanks :)

Hi Georgia Hunter - pleased to meet you! I am a pharmacist as well, which is why I am getting lots of medication questions! And I love answering them.

I am totally with you on the super mega doses. I prefer to stay within the MDD guidlines. My Dr is very cautious, which is why I like her so much. Delmar - I would be concerned about the azithro dose, as Georgia said, but that is up to you and your doctor to decide. We are just stating our opinions, so please don't panic!!

Also Georgia - I am very careful about debate on the forum, so please don't feel I am challenging you in any way. I just would like to know why you are against taking doxycycline and zithromax together? I know their mechanism of action is very similar, but they are in different classes since they do inhibit different proteins. I ended up taking doxy and zithro for about a month, and it helped me alot until I had to switch doxy to Septra bc of the sunlight issues once the springtime came. From what you wrote, I am assuming that your concern of taking them both together is in regards to resistance? From what I have gathered, Lyme bacteria does not develop resistance to antibiotics like other illnesses do. Please fill me in on this, because maybe you know something that I don't. Thanks.

Girlie - I would totally stay on the doxy if you can. If you recall I started at doxy 100mg twice a day, and after four weeks it was increased to 100mg three times a day, and then to 200mg twice a day. I would definitely work on increasing the doxy dose slowly if you are indeed going to stay on it, because 100mg twice a day isn't sufficient enough to fight the lyme for an extended period.

As for the zithromax dose, I am on 250mg twice a day, and it is sufficient, I would not push for a higher dose at the moment. 

Your plan of going off doxy and taking zithro instead and then going back on doxy - I see what you mean, I would discuss this carefully with the Dr. You can technically do that, but I would fear that the zithromax may not be enough to fight the lyme alone. I have seen people take amoxicillin alone, but not zithromax, but then again, I could be wrong. If I find anything out on this, I will let you know.

Take a Deep breathe, and handle one week at a time!! Hopefully you can handle the doxy until you see your LLMD and then go from there. Keep the questions coming, I don't mind at all !

it may hold things, it may not. let me look into this for you. I will let you know my findings.

Yes, you did ramp it up quick! just leave it as is for now, and i will get back to you on the zithro question.

Chap, we know that Borrelia just curls and balls up to prevent antibiotics from physically binding it's receptor sites. To me, it doesn't matter if we're targetting 30S or 50S, my concern with using both Doxy and a macrolide is efflux pumps in both Borrelia and with other pathogens. They're becoming a major form of resistance and combining the two over time would increase the use of efflux pumps tremendously. Strep and E coli both use efflux pumps a lot. It is my opinion that when we have Lyme, it's just not Borrelia that is causing the problems, it's the combination/concentration of Borrelia and our other bacteria that cause the issues. One study showed 48% of the test subjects had Borrelia and only 16% showed any symptoms of Lyme Disease. What Borrelia does is overload your immune system and your immune system has to deal with everything. IMO, your immune system even has to deal with pH levels in the body and Borrelia certainly puts out enough quinolinic acid. That's why eating an alkaline diet is so important. It frees your immune system or at least the elements used to buffer pH.

Strep is a huge problem in the intestines for many people and H pylori is a huge problem too, and not just for ulcers. At the Paracelsus Clinic, they don't use antibiotics at all and their cure rates are as high as they come. IMO, it is because they are able to control all the other bacteria as well.

Post Edited (Georgia Hunter) : 7/16/2014 5:08:50 AM (GMT-6)

Chappelle/Georgie: Re: developing tolerance. If that's the only reason not to combine doxy and zithro - maybe what I could do is add the zithro just prior to going off doxy, and then remove the doxy for the month of August (hot weather), then in September add doxy back - and just treat with the combo for a month, then remove the doxy and add septra ds to the zithromax.

The time of the two together would just be one month - probably not enough time to create a tolerance to one or other?

In fact, I may get away with only removing doxy for about 3 weeks. But the question is: will zithro hold my lyme from getting worse in that time frame.

Chapelle: You chose bactrim over rifampin to treat bartonella - any particular reason? My only concern of bactrim is that it can cause Stephen or Steven Johnson syndrome. (hope I have that right - it's the sometimes fatal syndrome that comes on quickly).

Hi Georgia, Chapelle, and Girlie.

I disagree with that if a tetracycline and macrolide are combined it increases resistance to both of them. Consistently it seems all LLMDs are reporting no antibiotic resistance for Lyme germs. The problem with the Lyme germ isn't the resistance, it is that it is so slow growing and it is sneaky in that it hides, goes metabolically inactive, makes biofilms, cyst forms, etc. Also if you combine antibiotics you are even more less likely to get resistance, similar to how HIV meds are combined to prevent resistance and be more effective like for example atripla. The more meds you combine the less likely resistance is to occur. So combining a tetracycline and a macrolide is less likely to develop resistance than prescribing either a macrolide or tetracycline alone. One is for 30S ribosome another for 50S. Also i read a Lyme germ would have to reproduce something like a million times to even have any form of mutation, the chances of that mutation giving it an antibiotic resistant gene? Again probably another one in a million. It just doesn't grow fast enough to become resistant. That is just my thoughts from what I read and know.

Girlie - I herxed for weeks once I started the doxy. It can last from one day to a few days to weeks - all depending on the treatment and the severity of the illness. Does your skin get itchy/pinchy? That's how I knew I was herxing, it was a clear sign for me.

I would not worry about taking zithromax and doxy for one month together at all

I am not too sure about the zithromax pulsing.

Georgia - I appreciate your input very much! Lymepickle worded his response well, and I do agree with him. For me, Doxycycline alone would not have been enough to battle the Bartonella, if I didn't add zithromax I would still have the Bart issues. Its the coinfections we have to worry about more than the Lyme in most cases.