Add another antibiotic?

[GraceUnderPressure]

I have been thinking about the responses I got to my question about doing ivig - specifically contemplating the possibility of trying to add another antibiotic to the zithromax we are already taking.

 

DS18 is positive for lyme & ambiguous for myco (Dr R thinks it's a very strong possibility based on ds's clinical eval). He's taking 500mg of zithromax in the am with a large dose of probiotics in the pm. He is also still on the herb lomatium.

 

Augmentin & doxycycline both caused him to develop diarrhea (Wondering whether that's considered a definite intolerance of the drugs or could it possibly be a herx rxn?)

 

What other abx are given along with zith? Should I ask Dr R for something like ceftin or biaxin &/or maybe flagyl? (He told us to find a LLMD but promised that he was not going to abandon us while we're waiting to get on board with the new dr)

[LNN]

If he's positive for lyme, I'd personally be advocating for a second abx before contemplating IVIG. Single abx treatment of lyme has a very high failure rate. Most LLMDs will do a combo of abx and rotate that combo as time goes on. If lyme, then IVIG may help in his treatment but it wouldn't be "the" single treatment. You'd still need to be doing the abx combo. So yes, I'd definitely be asking to add a second abx.

[MichaelTampa]

The Burrascano guidelines on the ILADS site suggest adding hydroxychloroquine or amantadine to zithromax. The amantadine does something specific to help the zithromax, it may be pH related, I don't remember. At one point my llmd was going to give me amantadine along with zithromax. At the last minute we changed direction a little and it changed to ketek (telithromycin) instead of zithromax and then he said I didn't need the amantadine with it. You will not the Burrascano guideline comments are very consistent with that thinking. I think it changed for me, for some reason, we decided to go with factive (gemifloxacin), a 4th generation fluoroquinolone (more well known is levaquin, a 3rd generation f.q. for bart). Factive treats bart and borrelia, and perhaps for some reason the addition of factive meant that the switch from zithromax to ketek made sense.

 

So one thing to consider there is either adding amantadine or switching instead to ketek.

 

But you are also missing is a cyst buster such as flagyl or tindamax. All of the different combinations discussed/used for me above included tindamax. Of course GSE is known to be a cyst buster, too, although very caustic.

 

These guidelines are a fairly rare source of recommendations, at least somewhat up to date. They are getting a little old, note factive is not on there, as Burrascano has not been treating for a while now. But, still, a bit of a treasure for those trying to go at it without a truly experienced LLMD. I suggest you read them several times.

 

http://www.ilads.org/lyme_disease/B_guidelines_12_17_08.pdf