Friday, January 13, 2012

Continuous or pulsed

Two patients yesterday with neuropsychiatric symptoms responsive to amoxicillin. One patient claimed that Moxatag, a long acting drug, was more effective than traditional short acting amoxicillin. The other adamantly claimed the opposite.

The question about continuous therapy versus pulse therapy is controversial and unsettled.

At least one(Lyme)study showed that continuous exposure to drug, even at lower concentration was more effective(had better killing kinetics).

Test tube study.

Clinical support: Long acting Bicillin (penicillin) works very well despite low blood/tissue concentration of drug.

Amoxicillin reaches a peak blood level without hours and is rapidly excreted with preferential penetration to some tissues. In-vivo(you), tissue concentration may be higher than shown with in-vitro(test tubes). Don't know.

IV antibiotics with long half lifes - Rocephin and Zithromax can be very effective.

Oral antibiotics behave differntly in the body than IV for a number of reasons.

I currently prescribe amoxicillin as 500 mg, two twice daily. Perhaps one four times per day would work better. There are practical limitations: better adsorption on an empty stomach, scheduling doses.

My impression: continuous better than pulsed.

8 comments:

la quinta kid said...

"Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Treatment of Disseminated Infection"

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029914

This might help to shed some light on the lyme controversy.

Curtis said...

Personally I've always been against the idea of pulsing but I was surprised to see this line in the macaques study: "Finally, the use of variable and pulse-dosing regimens of antibiotics may improve efficacy [43] and this warrants testing in an appropriate model."

Karen said...

pPulsing seems to be popular with another local llmd. His theory is that these are slow growing organisms, so you don't need to hit them daily. What are the ramifications of doing these drugs intermittently? Especially a drug like, rifampin?

MJ said...

"I currently prescribe amoxicillin as 500 mg, two twice daily. Perhaps one four times per day would work better. There are practical limitations: better adsorption on an empty stomach, scheduling doses." You mean orally? empty stomach? ok!! wow!

glytzhkof said...

I agree that the slow growing nature of these pathogens may make continuous antibiotics use more harmful than beneficial since it also destroys your natural gut flora which in turn can trigger new health problems.

I did Doxycycline for a long time, and it kept me on my feet, but I didn't get better, and never felt too good when on them. I also found it problematic to get enough milk and calcium into my body when doing so much antibiotics. I need calcium, vitamin d and k due to bone loss from high metabolism.

After bombing back Lyme with Clarithromycin & Plaqunil for 3 x 8 weeks repeated treatment (Augsburg Protocol) with significant periods between the 3 cures and some supplemental high dose Flagyl at the end of each cure, I felt a lot better. Now my focus is balance and to try and have my own body fight the infection more effectively.

Seeings as I have an auto-immune disease - Graves disease - resulting from Lyme, this may be a bit of a risk, but I don't want to be on antibiotics all the time. I take medication for thyroid hormone control, and watch the levels of antibodies. When they are very high a short cure of antibiotics seems to trigger a sharp decline in those levels after some delay. I interpret this as a reduction in "active lyme" or in other words the destruction of the Lyme pathogen in spirochete form (corkscrew). Don't know if it is correct of course, but I believe so.

I actually think chronic Lyme patients should be asked to decide themselves "when to pulse" - since I can guarantee you they will know when the disease is in a very active state. In my opinion heavy antibiotics used continuously against dormant Lyme is like shelling Iwo Jima.

Plaqunil is a scary medication btw when you read the side effects, but this medication "did something" that made me improve a lot when supplementing with Clarithromycin.

glytzhkof said...

Also want to underscore that before I read up on antibiotics properly, I think I wasted a lot of medication by mixing it with milk and supplements against Lyme.

When you pulse for a shorter period of time with higher dose it is easier to ensure you follow very strict nutritional procedures to maximize the effectiveness of the medicine.

Far too many Lyme sufferers take all kinds of nonsense and end up hurting the treatment prescribed by their doctors.

T9im said...

Hi Doc:

la quinta kid references a newly released / published Rheus Monkey study (doesnt' look to be the one referenced in Pam W's Cure Unknown that was supposedly to be released in conjunction with the Kempler study).

I think you'll like it.

Camp Other said...

Karen wrote,

"What are the ramifications of doing these drugs intermittently? Especially a drug like, rifampin?"

I'd like to know that, too. My understanding is that it isn't good to stop rifampin and restart it again. If I recall correctly, it's harder on the liver, side effects and their severity increase if one stops and restarts, and it also encourages antibiotic resistance. It's particularly bad with rifampin/rifampicin.