Thursday, December 4, 2008
Novel combinations of Lyme medications
It is hard to predict how patients will respond to antibiotic combinations. As I review records of patients that I have treated over several years, I have noted that Doxycyline in combination with Plaquenil had been very effective. I was using this before I became more "Lyme literate" and discovered that Burrascano and Donta claimed that Plaquenil was only effective with macrolides. I saw a patient yesterday who has had chronic Lyme disease. She presented mostly with fatigue, brain fog and muscle/joint pain. She was in the past diagnosed by a rheumatologist with a mixed connective tissue disorder. She had borderline auto-antibody immune indicators-low level RF and ANA. She was treated with prednisone and methotrexate with a poor response. Her condition devolved into what was called fibromyalgia before I began treating her. I have found that quinolones, particularly Cipro can be very effective for fibromyalgia symptoms. In this case I used Cipro in combination with Amoxicillin. She had a good response. She became 60% better. I then added Flagyl. She "loved" Flagyl. She felt much better. She was perhaps 80% better. This process transpired over about 18 months. She would try off antibiotics and relapses would occur.(Other antibiotics were used but this combo was the most effective consistently) Two months ago the Flagyl wasn't working as well. She was back down to the 60% better level. I tried something different: Amoxil- Cipro(250mg twice daily) and Plaquenil. The Flagyl was stopped. She returned for follow up. Plaquenil was magic. For the first time in decades- she was 100% better. Perhaps this relates to her tendency for autoimmune responses. Nonetheless, this is an example of how experimentation with atypical combinations of Lyme agents can pay off.