Question: Studies for LLMD, indication for pulsed mino?

[NancyB]

Hi,
My LLMD generally doesn’t pulse tetracyclines and I was talking to his NP who said they would be interested to see any studies where pulsing was used.

I’ve been going through the studies/articles listed on the other part of the site. I have access to a university library online, but many of the articles from the 90’s are not available online, so I can’t see the details. So far, found the London study which used pulsing–3 days/wk. The MIRA study used 200mg/day….any other studies that confirm Dr. Brown’s use of pulsed therapy?

I know it depends on the individual patient and co-infections in terms of what works best, but just want to give them as much info as possible.

Thanks!

[lynnie_sydney]

Nancy – Dr Brown’s pulsed protocols were not addressing Lyme Disease (relatively recently discovered,)rather Rheumatic Diseases (primarily RA and SD) that he posited were triggered by mycoplasma. Lyme protocols are generally different to AP – which has tended to be monotherapeutic (in some though not all cases) and in relatively low doses and often pulsed. Lyme treatments – which are usually addressing multiple pathogens at various stages of the life cycle – tend to be in much higher doses, in combination protocols and can be addressing more than rheumatic manifestations. You would be better searching for clinical research studies on the sites that are specific to Lyme Disease. here’s one: http://www.aldf.com/Research_and_Clinical_Studies.shtml

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[Lynne G.SD]

Hi Nancy;
I have been around this site for 14 years and never heard about Lyme until a few years ago.The only protocol that I know of that uses pulsed AP is the Marshall protocol.My sister who has MCTD and Lupus is on it and to tell the truth she is doing much better than I am.I am on the traditional heavy duty dosage of 6 rotating antibiotics and 2 herbals.

[Lynne G.SD]

Oops;forgot to mention that Sis also has Lyme which she contracted by mosquitoes,lives in the Yukon where Lyme is not even supposed to exist.It comes in on migrating birds which get bitten by mosquitoes and passed on to their next victims.

[Maz]

Hi Nancy,

There was the Charing Cross Hosp (UK) trial that you already found that was published in 2006, using a combination of oral, pulsed tetracycline and IV clindamycin for RA:

http://www.ncbi.nlm.nih.gov/pubmed/16465651

Unfortunately, a later randomized, double-blind trial, published in 2011, didn’t have quite the same positive outcomes, but there are many reasons why it probably wasn’t successful, including the fact that they only ran the trial for a half-year and didn’t use minocycline or doxycycline. Degree of severity was also not discussed in any detail and it’s pretty well-known, anecdotally that those with severe disease or those who have been withdrawn from other meds, cold-turkey, have a much harder time controlling early inflam from herxing.

http://www.hindawi.com/journals/ijr/2011/585497/

Anyone who understands the rationale for AP also knows that it’s a long-term therapy and that few, if any, RAers should expect to be in complete remission by 6 months???! Brown often remarked that he expected most RAers to be approaching or in remission between 2 to 5 years.

As Lynnie already mentioned above, Lyme treatments vary significantly from low dose AP used by Brown, purely by virtue of the fact that a different type of bug is being targeted that usually co-exists with multiple coinfections, requiring a heavy-hitting combo approach. That said, many LLMDs are also finding that quality of life is important for their patients and that many of the really sick ones have a good deal of trouble detoxing when there is a lot of inflam…leading to the vicious cycle of hypersensitivity that Dr. Brown described in the book. So, LLMDs are becoming more adept at titrating doses to patient tolerance while also ensuring they are covering corners on all the pleomorphisms of Lyme and the various coinfections involved in a particular patient’s pathogen load. It’s really a careful balance of ensuring that resistance doesn’t form by using too small a dose, while also hitting as many forms of borreliosis at once as possible. This said, LLMDs do use pulsing methods, but just not the same intermittant dosings that Brown used. They tend to use pulses in a longer fashion, such as 2, 3 or 6 weeks on with a week or so off for a wash-out. No studies on this, to my knowledge…it’s just pulses that are used by experienced LLMDs who understand the life-cycles of the organisms they’re treating. Garth Nicholson also mentions pulsing regimens on his website at http://www.immed.org and I’m pretty sure there is something about this in the Burrascano treatment guidelines (2008).

Until a chronic form of Lyme is acknowledged, long-term studies of antibiotic therapy for Lyme are not likely to be conducted to any great degree. There is the following from 2011 in relation to neurologic Lyme, but it is not “pulsed” therapy:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3177589/

And a more recent publication drawing out the flaws in the earlier Klempner study that has been used by the IDSA to deny longterm therapy to Lyme patients:

http://www.sciencedirect.com/science/article/pii/S1551714412002030

Sorry this isn’t of any further help, but Lyme really is a different kettle of fish to low dose AP and it’s actually even amazing that the Charing Cross Hosp trials were even given the time of day.

[NancyB]

Thanks for your responses. It looks like there was only the one published trial showing benefit with pulsed dosing, of course, as we know it’s all variable depending on infections present, the individual’s immune system, etc. I was just wanting to demonstrate that there are doctors who have had success with pulsing tetracyclines, because our doc normally pulses other antibiotics, but not the tetras.

Thanks again.

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