Post by Jeff on Jul 22, 2005 14:55:55 GMT -5
TREATMENT
a. PHILOSOPHY
Given the plethora of symptoms, signs, illness levels, disease expressions, and unexpected response to medical agents of any kind, all treatment is necessarily empirical, thus highly individualized. Presently, treatment is directed at TWO distinct organisms with distinctly different symptoms and signs. These are Borrelia, and Babesia/ Toxoplasmosis. This new paradigm and its ease and enhanced treatment effectiveness now drives us to a single FIRST approach in most patients:
Treat with oral Azithromycin and Atovaquone (see B or C below)
1. Atovaquone, 750 mg/ 5ml, 210 ml bottle or packs. Take one teaspoon (5 ml) twice daily with food. Refill X 2.
2. Azithromycin, 250 mg, #60. Take one tablet twice daily with food. Refill X 5.
3. Diflucan, 100 mg, #10. Take one tablet weekly and as needed for yeast overgrowth. Refill X 5.
4. Metronidazole ER, 750 mg, # 5. Take one weekly. Refill X 5.
In variants of the illness with serious neurological or psychiatric presentation, we presently begin by substituting the 12-week Ceftriaxone protocol for the Azithromycin, but combine with the Atovaquone.
19
b. ANTIBIOTICS
A. Antibiotics effective against BORRELIA:
1. Orals Best choices in our experience to date are
(considering efficacy, low flare effects, and compliance. If cost is a consideration, the level is shown below as H, M or L):
• Azithromycin, 600 mg QD (H)
• Clarithromycin XL, 500 mg QD (H)
• Cefuroxime, 500 mg BID (M)
• Minocycline, 100 mg BID (L/M)
• Cephalexin, 500 mg BID (L)
• Amoxicillin, 1,000 mg TDD (L)
• Metronidazole ER, 750 mg QD (M), or 250 mg TK>
—"Cyst form" only (H)
2. Intramuscular (IM) [Most of our parenteral experience is with this single drug. It is several times more effective than any oral, and has minimal flare effect.]
• Ceftriaxone, one gram IM daily.
3. Intravenous (IV) (As above, one drug, high efficacy, low flare effect.)
• Ceftriaxone, 2 grams BID for 12 weeks. Repeat cycle only once if required.
B. Antibiotics effective the protozoans BABESIA and TOXOPLASMOSIS:
1. The only recommended safe and effective treatment of these two organisms are the following two drugs:
• Azithromycin, 250 mg twice a day with meals (breakfast and dinner)
• Atovaquone (Mepron), 5 ml (one teaspoonful) also twice a day with the same meals.
C. Antibiotics effective against both Borrelia and a presumed protozoan: The same as B.
20
D. Sources:
1. All oral antibiotics are PDA approved, and purchased through local or US Mail-Order pharmacies, typically through medical insurance co-pay. Long-term high-cost antibiotics such as azithromycin are sometimes not approved, or at least often require "Prior Approval" paperwork. Biaxin may be substituted. Diagnostic codes should include Babesia (088.82) if it is found or part of treatment rationale.
2. IM ceftriaxone (Presently only sold as Rocephin until December 2004, when it becomes available as a generic.) One-gram vials seem to be readily gotten through local or Mail-Order pharmacies via prescription. Concurrent prescriptions are required for the following required equipment:
• Lidocaine. 1%, 100 cc/month (two 50 cc bottles preferred). Mix 2. Ice with each one-gram vial of ceftriaxone until clear yellow.
• Syringes, disposable, 30cc, 30 per month. Use one daily.
• Needles, 25 gauge, 1 Vz inches, 30 per month. Use only for the actual injection.
• Needles, 18-20 gauge, 1 inch, 30 per month. Use only for fluid transfer between bottles (that can cause tip bending).
3. IV Ceftriaxone should be given by professionals trained to do so, such as Home Health agencies. Insurance often will not cover this method because of exorbitant cost. Orders (describing details) for the only effective protocol we now consider useful are attached.
4. Patients whose insurance will not cover IV ceftriaxone, but who have extremely debilitating or progressive courses can find alternative, less expensive drug sources. Safety, however, is paramount, and there must be assurance of quality line placement and care, and medication mixing and infusion. See attached information.
21
E. TREATMENT LENGTH
1. Azithromycin: Continue from the first day without a break until symptoms have disappeared or plateaued for more than 3 months.
2. Atovaquone: Give one course (bottle or box... typically for 21 days). Stop a week, then give the second course. Most patients will not require more than three courses, although CNS recovery will continue for another 3-4 months to resolution.
F. CONTROLLING SYMPTOMS
The technique is straightforward, and involves only in cutting the dose back... or even stopping the antibiotic briefly... until bacterial load drops sufficiently that severe flare effects are no longer a big problem. Patient and physician have to "feel" their way through treatment startup in some patients. Most can begin and continue at full dosing, however.
a. PHILOSOPHY
Given the plethora of symptoms, signs, illness levels, disease expressions, and unexpected response to medical agents of any kind, all treatment is necessarily empirical, thus highly individualized. Presently, treatment is directed at TWO distinct organisms with distinctly different symptoms and signs. These are Borrelia, and Babesia/ Toxoplasmosis. This new paradigm and its ease and enhanced treatment effectiveness now drives us to a single FIRST approach in most patients:
Treat with oral Azithromycin and Atovaquone (see B or C below)
1. Atovaquone, 750 mg/ 5ml, 210 ml bottle or packs. Take one teaspoon (5 ml) twice daily with food. Refill X 2.
2. Azithromycin, 250 mg, #60. Take one tablet twice daily with food. Refill X 5.
3. Diflucan, 100 mg, #10. Take one tablet weekly and as needed for yeast overgrowth. Refill X 5.
4. Metronidazole ER, 750 mg, # 5. Take one weekly. Refill X 5.
In variants of the illness with serious neurological or psychiatric presentation, we presently begin by substituting the 12-week Ceftriaxone protocol for the Azithromycin, but combine with the Atovaquone.
19
b. ANTIBIOTICS
A. Antibiotics effective against BORRELIA:
1. Orals Best choices in our experience to date are
(considering efficacy, low flare effects, and compliance. If cost is a consideration, the level is shown below as H, M or L):
• Azithromycin, 600 mg QD (H)
• Clarithromycin XL, 500 mg QD (H)
• Cefuroxime, 500 mg BID (M)
• Minocycline, 100 mg BID (L/M)
• Cephalexin, 500 mg BID (L)
• Amoxicillin, 1,000 mg TDD (L)
• Metronidazole ER, 750 mg QD (M), or 250 mg TK>
—"Cyst form" only (H)
2. Intramuscular (IM) [Most of our parenteral experience is with this single drug. It is several times more effective than any oral, and has minimal flare effect.]
• Ceftriaxone, one gram IM daily.
3. Intravenous (IV) (As above, one drug, high efficacy, low flare effect.)
• Ceftriaxone, 2 grams BID for 12 weeks. Repeat cycle only once if required.
B. Antibiotics effective the protozoans BABESIA and TOXOPLASMOSIS:
1. The only recommended safe and effective treatment of these two organisms are the following two drugs:
• Azithromycin, 250 mg twice a day with meals (breakfast and dinner)
• Atovaquone (Mepron), 5 ml (one teaspoonful) also twice a day with the same meals.
C. Antibiotics effective against both Borrelia and a presumed protozoan: The same as B.
20
D. Sources:
1. All oral antibiotics are PDA approved, and purchased through local or US Mail-Order pharmacies, typically through medical insurance co-pay. Long-term high-cost antibiotics such as azithromycin are sometimes not approved, or at least often require "Prior Approval" paperwork. Biaxin may be substituted. Diagnostic codes should include Babesia (088.82) if it is found or part of treatment rationale.
2. IM ceftriaxone (Presently only sold as Rocephin until December 2004, when it becomes available as a generic.) One-gram vials seem to be readily gotten through local or Mail-Order pharmacies via prescription. Concurrent prescriptions are required for the following required equipment:
• Lidocaine. 1%, 100 cc/month (two 50 cc bottles preferred). Mix 2. Ice with each one-gram vial of ceftriaxone until clear yellow.
• Syringes, disposable, 30cc, 30 per month. Use one daily.
• Needles, 25 gauge, 1 Vz inches, 30 per month. Use only for the actual injection.
• Needles, 18-20 gauge, 1 inch, 30 per month. Use only for fluid transfer between bottles (that can cause tip bending).
3. IV Ceftriaxone should be given by professionals trained to do so, such as Home Health agencies. Insurance often will not cover this method because of exorbitant cost. Orders (describing details) for the only effective protocol we now consider useful are attached.
4. Patients whose insurance will not cover IV ceftriaxone, but who have extremely debilitating or progressive courses can find alternative, less expensive drug sources. Safety, however, is paramount, and there must be assurance of quality line placement and care, and medication mixing and infusion. See attached information.
21
E. TREATMENT LENGTH
1. Azithromycin: Continue from the first day without a break until symptoms have disappeared or plateaued for more than 3 months.
2. Atovaquone: Give one course (bottle or box... typically for 21 days). Stop a week, then give the second course. Most patients will not require more than three courses, although CNS recovery will continue for another 3-4 months to resolution.
F. CONTROLLING SYMPTOMS
The technique is straightforward, and involves only in cutting the dose back... or even stopping the antibiotic briefly... until bacterial load drops sufficiently that severe flare effects are no longer a big problem. Patient and physician have to "feel" their way through treatment startup in some patients. Most can begin and continue at full dosing, however.