Breaking Treatment Plateau
July 2014
Email from Dr. B
One of the techniques I used with many of my patients to break a treatment plateau is to cycle antibiotic therapy on and off based on the clinical symptoms and their intensity. When applied correctly, this invariably broke the plateau and allowed the patients to go on to recover!
Let me explain:
The usually used antibiotics will kill Borrelia only during their growth phase. So during a prolonged course of treatment, after initial improvement occasionally there is a plateau- not getting better but not getting worse. Presumably the Borrelia and the antibiotics are in a stalemate- not growing but not being killed. So what I then did was to totally stop all treatment (all antibiotics and all herbs if any were being taken).
Over the next few days, the patients felt a little better as the antibiotics washed out and any mild Herxheimers halted. By the third week off, because of the four-week growth/regeneration cycle of Lyme Borrelia, symptoms began to creep back.
But now, obviously, the Borrelia are growing again! They are again susceptible to antibiotics.
So I would resume full dose therapy and sure enough, there would be a Herxh that would settle down over the next few weeks. When back on a plateau, which in most people meant after about six weeks of meds, I would again halt treatment and the cycle would repeat.
In most cases, this worked out to being off about 3 to 4 weeks, and then on for about 5 to 6 weeks. Critically, this cycle is determined solely by symptoms and not by the calendar!
In general, it took three full cycles to get the remaining infection controlled such that I was able to stop treatment and the patients remained well.
I began using this approach many years ago, well before the concept of “persisters” was presented.
However, the idea is the same- Borrelia, like treponemes, can have prolonged “latent” periods in which they remain viable, but grow and reproduce little if at all, yet nevertheless continue to cause symptoms due to cytokine activation, presumably because they continue to secrete antigenic materials (blebs, DNA, glycoproteins, etc.).
By treating steadily for as many months as is necessary to reach this plateau, and then cycling treatment, an increased rate of success can be achieved.
Note this applies to Borrelia only and not to the co-infections.
I hope this is helpful- feel free to share!
Dr. B……………..!
EMAIL From Dr. B...
July 2014
From Dr. B
A few points-
First, nobody knows how long one must be on meds to control persisters. Bactrim, like any other med taken long term, should be monitored with appropriate tests.
Years ago there was lots of talk about a regimen in Europe that combined Bactrim with roxithromycin (a weaker version if Biaxin). Some claimed it was a miracle while others were not impressed.
However back then nobody thought in terms of persisters and nobody separated out those stuck on a plateau from those still with actively moving disease.
Because Bactrim was not supposed to work for Lyme some thought it must be hitting coinfections.
Time for a study!
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See Dr. Burrascano's 2005 Study on Treatment Resistant Lyme.