doxycycline question

[illinwithoutacause]

hello, everyone~

so, i was reading burrascano's treatment guidelines re: antibiotics which i thought were interesting.  i found the following passage:
--begin quoted material--
There are four types of antibiotics in general use for Bb treatment. The tetracyclines, including doxycycline and minocycline, are bacteriostatic unless given in high doses. If high blood levels are not attained, treatment failures in early and late disease are common. However, these high doses can be difficult to tolerate. For example, doxycycline can be very effective but only if adequate blood levels are achieved either by high oral doses (300 to 600 mg daily) or by parenteral (IV) administration.
--end quoted material--

so here, if i understand him correctly, burrascano is saying that doxy is "bacteriostatic" which means that it prevents further proliferation of the bacteria, but does not necessarily kill them off--become "bactericidal"--unless you have high levels of the medication in your system.

so, in light of this, would it make sense that my symptoms would not be disappearing more rapidly (i've been on 200mg doxy/day treatment for a month), and that i am not having more obvious herxes if my bacteria levels are being diminished rather than having an intense die off?

or maybe i'm just trying to develop this hypothesis to make myself feel better about this path i am on?

dunno.

any thoughts??
binx

[wonko]

If the current dose is to try and light up the western blot, then that makes sense why the dose is low and why it is the only abx for now.  

My LLMD kinda skipped that step.  My first Igenex western blot was overall CDC negative, though I had enough to be Igenex positive for IgG.  I wish I had repeated the test early in treatment, but I didn't ask and my doc didn't order.  I did get a 2nd IgM only Igenex western blot more than a year into treatment, and more bands showed up on it than on my first, but all with only 1 "+" sign.

I never really felt the testing was that strong in my case, but wonder if I'd gotten another round done early into treatment if I would have something more solid on which to hang my dx.  So while the waiting is painful, hopefully it will help build a stronger case and/or guide you and your doc to other possibilities.

Despite this one regret, I do think that my doc had plenty of data.  When I first came to his office I had a thick binder of tests, letters, MRI files, etc., and he spent about 3 hours with me reviewing my history and tests.  I sent a lot of this in advance and he had read all that I sent, there where flagged and underlined items and such.  That impressed me a lot, as a lot of other specialists I'd seen up to that point would spend <15 minutes on me and would disregard any paperwork I brought with them, usually saying how they'd do their own tests or make their own observations.  (I think that translates to "I want to bill your insurance for my services instead of taking a minute to read the results of the last guy.")

Anyway, kinda rambling off topic but just wanted to say that your course makes sense given what your doc is trying to accomplish.  Hang in there!

[JackieCalifornia]

Binx--i think you've ended up at the right place in your musings. LLMDs are wise to approach each patient individually in assessment, diagnosis and treatment, and it sounds like that is the course yours is following. I would do what you are doing, following the current course but keep your analytical antennae up just as you have above. I worry abt docs who don't do much data collection before jumping to treatment, so I would be comforted by these careful steps your doc is taking...tho it's hard to wait, I know!! Take care.

[illinwithoutacause]

hello there,

thanks for taking the time to entertain my completely uneducated theories about my situation.

jackie--i did not test positive for any co-infections.  just igg pos for band 31, ind band 41, igm pos for band 30 and ind band 41.  i also had a slightly low cd57 & very elevated c4a.  the LLMD (your same doc) prescribed 100mg doxy 2x/day for 2 months, and gave me another lab slip to have repeat testing done.  he will see me again a month later to go over results.

wonko--i appreciate your giving me the rundown of your experience.  i know you asked me before what the doc's approach is, and i must've spaced on responding.  (imagine that!)  anyway, my LLMD hasn't established a complete treatment protocol with me yet, but put my on doxy just to see if he could "stir things up" a bit and then re-test.  he said he has had many patients who have more bands show up after this kind of trial.  we'll see what happens and whether he wants to do combination meds after that.  i hope that is indeed the case rather than his cutting me loose to twist in the wind without a diagnosis again.

carrie--i am going to reschedule with doc for july.  i will go in a month to get my blood drawn again, and, like i said to wonko, i think you're right that he gave me a lower dose to get the bugs activated.  he will also do PCR testing this next round as well.

thank you, again, for humoring me.

blessings to one and all,
binx

[carrie235]

Hi Binx,

I'm going to start a separate post shortly.  Regarding Jackie's comment, last time I saw Dr. S, he mentioned that he would want to start my on Flagyl (sp?) because is it a cyst buster or something like that.  So, I know he plans on adding medication probably next time I see him.

Currently, I am on 1000 Amoxicillian 2x per week and 500 Mg. Biaxin twice per day.  When I first started my treatment, for the first 2-3 weeks, I misread the directions and was only taking 500mg Amoxicillian 2x per day and the 500 Mg Biaxin twice per day.

Your post about the levels of doxy was very interesting though and I can see why you are questioning your dosage.  I am wondering if Dr. S was giving you a smaller dose just to get the lyme activated for your upcoming blood test.  When is that?  And, then once he knows what he is working with, he'll treat accordingly..??

[wonko]

While you have your guidelines out, you should look for the section that discusses combination therapy (multiple abx).  This is not only for co-infections but to also address the different forms that Lyme bacteria can take to hide in the body.

I think I've asked you before if you know your LLMD's approach.  My doc starts low and slow on a single antibiotic but ramps up as the patient can tolerate.  

If I dig back to the memories of when I began treatment, I started out doing a few weeks of samento, then I started on a very low dose of mino.  While on just the mino I wasn't sure if much was happening, but I thought "maybe."  Then my LLMD added zith, and I had a more pronounced reaction (including a rash characteristic of Bartonella).  

In my (non-medically trained) opinion, based on my experience and what I've read from others, using combinations is more effective than so-called monotherapy.  And I've mostly been on low doses and still seeing improvement, so again in my opinion the use of combinations is more important than the issue of dose.  I know sometimes you want an obvious response to signify that you're on the right track, but Herxing is really tough on the body and therefore my LLMD says that strong Herxing can set you back.  But yes, different LLMD's take different tracks.

I confess to not really understand the different forms of bacteria, but I have my own anecdotal evidence of it.  I first took Tindamax, an abx said to attach the cyst form, about a year into treatment.  I had *just* resumed full time work.  The tindamax sent me spiraling back to "square one."  Luckily, it was the holidays and I was able to use vacation time and holiday days off to cover up my condition.  And extra luckily, while it threw me way back, I regained an improved level of health much faster the "second time around."  In fact, it was around that time that I secured my new job, so I must've been doing something right or appearing to be at the time, lol.

I don't know how often you get to see your doc or if you can ask his/her office questions, but given your situation and lack of (obvious) response, I think it would be reasonable to ask about what they plan to do with your treatment.  Or if you know other patients of the same doc who have been treating longer, see if you can get a feel for how their treatment was adjusted over time.  I know one thing that I think my LLMD does very well is that he adjusts treatment based on how the patient feels and responds to abx.  I don't know if all docs personalize treatment to that extent, but I assume most will do some tailoring.

Good luck.

[JackieCalifornia]

Binx, sorry I can't do any research at the moment but if you are being treated first for a coinfection, perhaps it takes a lower dose than lyme itself needs. Just a thought. But if the answer is 'no coinfectionsn, then yeah, I'd be asking the same question you are.