Post by Niels on Oct 28, 2006 2:37:43 GMT -5
The reason why I post about tetracyclene is twofold.
(1) tetracyclene, according to 'Tetracycline therapy targets intracellular bacteria in the filarial nematode Litomosoides sigmodontis and results in filarial infertility' article above, helps inhibit some bacterial
symbiotes of nematode infections. Whether this is the case with morgellons is unknown, however,
the evidence of initial success with "old schwartz protocol" of high-doses of Septra-DS (SMZ/TMP)
may be due to the same effect of nematode fertility reduction caused by suppressing bacteria.
(Eventual relapse is due, perhaps, to eventual development of resistant bacteria, or symbiotic
help from nematode host to block antibiotic).
(2) tetracyclene appears to be a good medicine to fight Lyme Disease. The issue for many Lyme patients, including myself, is that our insurance will not cover extended treatment needed for
a proper "cure" of Lyme disease. Typically they begin to balk or flat out refuse after a few
months, citing treatment guidelines of 1 month by the FDA/CDC/AMA... if one actually wants
to pursue the course of action recommended by an LLMD, one ends up paying out of pocket
for some outrageously expensive antibiotics.
Tetracyclene is available as a veterinary medicine without a prescription. It is available as powder
or pills (e.g. cow bolus). So you can give yourself the dose you need, for the lengh needed, and
not bother with all the hassle of idiot-non-lyme/morg-literate-insurance-doctors, insurance
that won't take scrips from an LLMD, and being left in the lurch regarding my treatment due
to an outreageous difference in opinions on the diagnosis and treatment of Lyme....
--------
www.journals.uchicago.edu/CID/journal/issues/v25nS1/jy09_52/jy09_52.web.pdf?erFrom=4983620512890253740Guest
Tetracycline Therapy for Chronic Lyme Disease
Sam T. Donta From Boston University Medical Center and Boston Veterans Affairs
Medical Center, Boston, Massachusetts
Two hundred seventy-seven patients with chronic Lyme disease were treated with tetracycline
for 1 to 11 months (mean, 4 months); the outcomes for these patients were generally good. Overall,
20% of the patients were cured; 70% of the patients’ conditions improved, and treatment failed for
10% of the patients. Improvement frequently did not take place for several weeks; after 2 months
of treatment, 33% of the patients’ conditions were significantly improved (degree of improvement,
75%–100%), and after 3 months of treatment, 61% of the patients’ conditions were significantly
improved. Treatment outcomes for seronegative patients (20% of all patients) were similar to those
for seropositive patients. Western immunoblotting showed reactions to one or more Borrelia burgdorferi–
specific proteins for 65% of the patients for whom enzyme-linked immunosorbent assays
were negative. Whereas age, sex, and prior erythema migrans were not correlated with better or
worse treatment outcomes, a history of longer duration of symptoms or antibiotic treatment was
associated with longer treatment times to achieve improvement and cure. These results support the
use of longer courses of treatment in the management of patients with chronic Lyme disease.
Controlled trials need to be conducted to validate these observations.
[....]
Discussion
The optimum criteria and methods for the diagnosis and
treatment of chronic Lyme disease remain to be defined. Most
practitioners use a clinical definition that includes a combina-
tion of symptoms and signs with or without positive serological
support [14], but there are some who advocate a diagnosis that
requires positive serologies [16]. A recommendation was made
at a meeting of territorial public health officers in the fall of
1995 that western blotting be done only to confirm screening
EIAs that reveal positive antibody titers [6]. According to our
results and a physician survey [14], this approach would not
diagnose 50% of the cases of chronic Lyme disease. Until
better criteria are established, it would seem advisable to re-
commend that western immunoblotting, especially testing for
IgM, be conducted for all patients who meet the clinical criteria.
IgM reactions may represent reactivation of latent disease
or persistent infection and have been noted in other chronic
infections (e.g., toxoplasmosis). Seronegative Lyme disease
is a recognized entity [17–19] (K. Kezler, R. C. Tilton,
M. Manak, and S. T. Donta, unpublished data), and our results
demonstrate that patients with similar clinical symptoms who
are seronegative have responses to antibiotic treatment that are disnot
distinguishable from those of seropositive patients (includ-
ing those who meet the current CDC criteria). These findings
also suggest that circulating antibody responses are not the
most relevant correlates of disease presence or activity. Until
better diagnostic tests are available to document the presence
and extent of infection, clinical criteria remain the mainstay of
diagnosis.
The optimum treatment for chronic Lyme disease also re-
mains to be delineated. No controlled clinical trials have been
conducted to date, yet there appear to be strong opinions regarding
the type and duration of any antibiotic therapy [20]. In contrast,
there is a consensus that a 3- to 4-week course of
therapy with a tetracycline or b-lactam antibiotic appears to
yield a successful outcome of the earliest manifestation of
Lyme disease (erythema migrans) [13]. Although it has yet to be
established whether all or most cases of chronic Lyme dis-
ease are due to persistent infection, our results support the
hypothesis that it is a persistent infection and provide the basis for
a reasonable approach to its management.
The rationale for our use of tetracycline hydrochloride for
the treatment of patients with chronic Lyme disease arose from
several observations. One observation was that patients being seen
in our Lyme disease clinic who had been previously
treated with b-lactam antibiotics, including iv ceftriaxone, were
not routinely cured or did not believe that their conditions were
significantly improved, even after several months of therapy;
serological tests for most of these patients were unequivocally
positive. Another observation was that patients treated with
doxycycline (100 mg twice daily) had some improvement in
their conditions that was not sustained.
When the pharmacologic properties of doxycycline and tetracycline
hydrochloride are compared, the absorption of doxycy-
cline is sometimes better at comparable doses, but 500 mg of
tetracycline three times daily achieves higher serum levels than
does 100 mg of doxycycline twice daily [21]. Because doxycy-
cline is also highly bound to proteins (which accounts for its
longer half-life), the amount of free drug available to diffuse
into tissues is less than that of tetracycline [21].
A third observation was the hypothesis that chronic Lyme disease
is a persistent intracellular infection. This hypothesis
draws support from what is known about other chronic infec-
tions, which most, if not all, have an intracellular reservoir
(e.g., Chlamydia, Legionella, Leishmania, Rickettsia, and
Mycobacterium tuberculosis infections). An intracellular loca-
tion could also explain the difficulties posed for b-lactam antibe
biotics as treatment of Lyme disease; this location is supported
by data from a tissue culture model of B. burgdorferi infection
in which ceftriaxone was ineffective against intracellular organfor
isms [22].
Our results show that a 3- to 6-month course of treatment
is associated with cure or significant improvement in 80%–
90% of patients with chronic Lyme disease. The most im-
portant determinant of treatment duration and outcome appears
to be the duration of symptoms before tetracycline therapy
(tables 4 and 5). Improvement was noted to begin as early as
1–2 weeks, but in patients with symptoms for 1 year, the
onset of any improvement frequently did not occur before
4–6 weeks of therapy had been given. It would not then be
surprising if both patients and physicians would conclude that
this mode of therapy was ineffective when there was no im-
provement after 3–4 weeks of therapy. This slow rate of im-
provement may correlate best with organisms for which the
rates of multiplication and metabolism are slow, as is known
for B. burgdorferi [23]. We speculate that the frequently noted
cycles of improvement and relapse could be consistent with
the varying metabolic activities of a heterogeneous population
of spirochetes.
Our results also show that tetracycline is apparently effective
in resolving symptoms associated with CNS function (i.e., cog-
nition and emotions); these symptoms are probably secondary
to encephalopathy. Recent studies with nonhuman primates
have demonstrated that the CNS, especially sensory functions,
is the main target of B. burgdorferi infection [24]. In this
setting, tetracycline penetration would not appear to be a major
limitation, as it might be in meningitis.
Our results suggest that the outcome for patients with symptoms
compatible with those of chronic Lyme disease is gener-
ally good when tetracycline is administered for 3–6 months.
Although this approach is relatively simple and inexpensive,
it needs to be validated by controlled clinical trials comparing
longer terms of therapy with short terms of therapy. Of great
interest as well would be trials comparing the outcome of iv
b-lactam therapy with that of tetracycline treatment.
(1) tetracyclene, according to 'Tetracycline therapy targets intracellular bacteria in the filarial nematode Litomosoides sigmodontis and results in filarial infertility' article above, helps inhibit some bacterial
symbiotes of nematode infections. Whether this is the case with morgellons is unknown, however,
the evidence of initial success with "old schwartz protocol" of high-doses of Septra-DS (SMZ/TMP)
may be due to the same effect of nematode fertility reduction caused by suppressing bacteria.
(Eventual relapse is due, perhaps, to eventual development of resistant bacteria, or symbiotic
help from nematode host to block antibiotic).
(2) tetracyclene appears to be a good medicine to fight Lyme Disease. The issue for many Lyme patients, including myself, is that our insurance will not cover extended treatment needed for
a proper "cure" of Lyme disease. Typically they begin to balk or flat out refuse after a few
months, citing treatment guidelines of 1 month by the FDA/CDC/AMA... if one actually wants
to pursue the course of action recommended by an LLMD, one ends up paying out of pocket
for some outrageously expensive antibiotics.
Tetracyclene is available as a veterinary medicine without a prescription. It is available as powder
or pills (e.g. cow bolus). So you can give yourself the dose you need, for the lengh needed, and
not bother with all the hassle of idiot-non-lyme/morg-literate-insurance-doctors, insurance
that won't take scrips from an LLMD, and being left in the lurch regarding my treatment due
to an outreageous difference in opinions on the diagnosis and treatment of Lyme....
--------
www.journals.uchicago.edu/CID/journal/issues/v25nS1/jy09_52/jy09_52.web.pdf?erFrom=4983620512890253740Guest
Tetracycline Therapy for Chronic Lyme Disease
Sam T. Donta From Boston University Medical Center and Boston Veterans Affairs
Medical Center, Boston, Massachusetts
Two hundred seventy-seven patients with chronic Lyme disease were treated with tetracycline
for 1 to 11 months (mean, 4 months); the outcomes for these patients were generally good. Overall,
20% of the patients were cured; 70% of the patients’ conditions improved, and treatment failed for
10% of the patients. Improvement frequently did not take place for several weeks; after 2 months
of treatment, 33% of the patients’ conditions were significantly improved (degree of improvement,
75%–100%), and after 3 months of treatment, 61% of the patients’ conditions were significantly
improved. Treatment outcomes for seronegative patients (20% of all patients) were similar to those
for seropositive patients. Western immunoblotting showed reactions to one or more Borrelia burgdorferi–
specific proteins for 65% of the patients for whom enzyme-linked immunosorbent assays
were negative. Whereas age, sex, and prior erythema migrans were not correlated with better or
worse treatment outcomes, a history of longer duration of symptoms or antibiotic treatment was
associated with longer treatment times to achieve improvement and cure. These results support the
use of longer courses of treatment in the management of patients with chronic Lyme disease.
Controlled trials need to be conducted to validate these observations.
[....]
Discussion
The optimum criteria and methods for the diagnosis and
treatment of chronic Lyme disease remain to be defined. Most
practitioners use a clinical definition that includes a combina-
tion of symptoms and signs with or without positive serological
support [14], but there are some who advocate a diagnosis that
requires positive serologies [16]. A recommendation was made
at a meeting of territorial public health officers in the fall of
1995 that western blotting be done only to confirm screening
EIAs that reveal positive antibody titers [6]. According to our
results and a physician survey [14], this approach would not
diagnose 50% of the cases of chronic Lyme disease. Until
better criteria are established, it would seem advisable to re-
commend that western immunoblotting, especially testing for
IgM, be conducted for all patients who meet the clinical criteria.
IgM reactions may represent reactivation of latent disease
or persistent infection and have been noted in other chronic
infections (e.g., toxoplasmosis). Seronegative Lyme disease
is a recognized entity [17–19] (K. Kezler, R. C. Tilton,
M. Manak, and S. T. Donta, unpublished data), and our results
demonstrate that patients with similar clinical symptoms who
are seronegative have responses to antibiotic treatment that are disnot
distinguishable from those of seropositive patients (includ-
ing those who meet the current CDC criteria). These findings
also suggest that circulating antibody responses are not the
most relevant correlates of disease presence or activity. Until
better diagnostic tests are available to document the presence
and extent of infection, clinical criteria remain the mainstay of
diagnosis.
The optimum treatment for chronic Lyme disease also re-
mains to be delineated. No controlled clinical trials have been
conducted to date, yet there appear to be strong opinions regarding
the type and duration of any antibiotic therapy [20]. In contrast,
there is a consensus that a 3- to 4-week course of
therapy with a tetracycline or b-lactam antibiotic appears to
yield a successful outcome of the earliest manifestation of
Lyme disease (erythema migrans) [13]. Although it has yet to be
established whether all or most cases of chronic Lyme dis-
ease are due to persistent infection, our results support the
hypothesis that it is a persistent infection and provide the basis for
a reasonable approach to its management.
The rationale for our use of tetracycline hydrochloride for
the treatment of patients with chronic Lyme disease arose from
several observations. One observation was that patients being seen
in our Lyme disease clinic who had been previously
treated with b-lactam antibiotics, including iv ceftriaxone, were
not routinely cured or did not believe that their conditions were
significantly improved, even after several months of therapy;
serological tests for most of these patients were unequivocally
positive. Another observation was that patients treated with
doxycycline (100 mg twice daily) had some improvement in
their conditions that was not sustained.
When the pharmacologic properties of doxycycline and tetracycline
hydrochloride are compared, the absorption of doxycy-
cline is sometimes better at comparable doses, but 500 mg of
tetracycline three times daily achieves higher serum levels than
does 100 mg of doxycycline twice daily [21]. Because doxycy-
cline is also highly bound to proteins (which accounts for its
longer half-life), the amount of free drug available to diffuse
into tissues is less than that of tetracycline [21].
A third observation was the hypothesis that chronic Lyme disease
is a persistent intracellular infection. This hypothesis
draws support from what is known about other chronic infec-
tions, which most, if not all, have an intracellular reservoir
(e.g., Chlamydia, Legionella, Leishmania, Rickettsia, and
Mycobacterium tuberculosis infections). An intracellular loca-
tion could also explain the difficulties posed for b-lactam antibe
biotics as treatment of Lyme disease; this location is supported
by data from a tissue culture model of B. burgdorferi infection
in which ceftriaxone was ineffective against intracellular organfor
isms [22].
Our results show that a 3- to 6-month course of treatment
is associated with cure or significant improvement in 80%–
90% of patients with chronic Lyme disease. The most im-
portant determinant of treatment duration and outcome appears
to be the duration of symptoms before tetracycline therapy
(tables 4 and 5). Improvement was noted to begin as early as
1–2 weeks, but in patients with symptoms for 1 year, the
onset of any improvement frequently did not occur before
4–6 weeks of therapy had been given. It would not then be
surprising if both patients and physicians would conclude that
this mode of therapy was ineffective when there was no im-
provement after 3–4 weeks of therapy. This slow rate of im-
provement may correlate best with organisms for which the
rates of multiplication and metabolism are slow, as is known
for B. burgdorferi [23]. We speculate that the frequently noted
cycles of improvement and relapse could be consistent with
the varying metabolic activities of a heterogeneous population
of spirochetes.
Our results also show that tetracycline is apparently effective
in resolving symptoms associated with CNS function (i.e., cog-
nition and emotions); these symptoms are probably secondary
to encephalopathy. Recent studies with nonhuman primates
have demonstrated that the CNS, especially sensory functions,
is the main target of B. burgdorferi infection [24]. In this
setting, tetracycline penetration would not appear to be a major
limitation, as it might be in meningitis.
Our results suggest that the outcome for patients with symptoms
compatible with those of chronic Lyme disease is gener-
ally good when tetracycline is administered for 3–6 months.
Although this approach is relatively simple and inexpensive,
it needs to be validated by controlled clinical trials comparing
longer terms of therapy with short terms of therapy. Of great
interest as well would be trials comparing the outcome of iv
b-lactam therapy with that of tetracycline treatment.