About Cpn

About Cpni

The first thing to understand is that Cpn (Chlamydophila Pneumoniae formerly known as Chlamydia Pneumoniae) is unlike most bacteria in that it cannot survive as an active organism outside your body's cells. Most bacteria can be treated fairly easily with antibioticsi because they circulate in the blood, this one cannot.

Living inside the cell gives Cpn several advantages:

It is not easily detected, if it is detected at all it is usually its footprint that it is found, such as traces of inflammationi or immunei sign posts.
It is protected from the immune systems by existing inside the cell, for most of its life cycle the immune system does not even see it or recognise it as a threat.
It does not need to generate its own energy source, it steals it from the cell.
Cells are very efficient at keeping noxious substances out, (to cells antibiotics might well be seen as noxious substances) so finding an antibiotic that penetrates the cells and affects the Cpn in any way is a precise exercise.

Another important aspect of Cpn which makes it different to ordinary bacteria and consequently more difficult to treat is that it has three life stages: EBs, RB, and Cryptic.

EBs stands for Elementary Bodies, they are spore-like forms whose only role is to spread the Cpn infection, the only stage at which Cpn circulates in the bloodstream. The EBs aim is to infiltrate a cell as soon as possible. At which point it will become an active RB.
RBs stands for Reticulate Bodies, the RBs are the active stage of the bacteria, their role is to produce a multitude of EBs which they do inside the cell, using stolen cell energy. They stop the cell from going through its natural life cycle and prevent its natural death (called apoptosisi). When the conditions are right the RBs will allow the cell to die and release EBs into the blood stream. If conditions are not right the RBs will convert to the cryptic formi of Cpn.
Cryptic Cpn is the hibernation phase, in this state they are not vulnerable to most antibiotics and are not active.

When treated with a Combined Antibiotic Protocol (CAPi), Cpn dies and as it does, it releases toxins and causes the immune system to produce inflammation in the process of clearing up, these events make people feel unwell. The level of discomfort people feel depends on their individual load of Cpn and the effectiveness of their immune system.

So where do you go from here? It is tempting to want to plunge straight into the treatment but there are several things that you need to think about before you get started.

This treatment can take a long time (months and years) and at first it is difficult to notice the small improvements you are making so you need realistic expectations.
You need to check your symptoms against those of the diseases associated with Cpn.
You need to be familiar enough with Cpn and the treatment protocol to be able to talk to your doctor who may not understand the difficulties involved in eradicating Cpn.
You need to be in the best condition you can be, by taking the recommended supplements which help your body cope with the die off effects of the treatment.
This treatment can be difficult to tolerate, although a significant number of people have very little in the way of reactions.
You need to get familiar with the website and the information it contains so you can find what you need to support your case with your doctor.
Expect to have to work at finding a doctor who will treat you. The number of patients undergoing this is small, the protocol is not well known by doctors. I would go so far as saying that a great many doctors would be suspicious of using multiple antibiotics for the length of time needed to eradicate Cpn.
Do not expect tests to be positive or accurate for the reasons explained above. Things would be a lot simpler if we could say to our doctors: “Look at these results, there is no doubt I have a Cpn infection.” Unfortunately that is not the way things are…

The other place to go is the FAQs section which may well answer some of your questions and point you to more information, including what tests to request.

Please read the site’s disclaimer statement and be aware that information in this document does not replace your doctor’s advice.

Expectations

What to Expect from the Treatment.

This treatment will not make you better overnight. Unlike most bacteria Cpni is difficult to get rid of and will take a long time to eradicate. If you think of it as similar to tuberculosis treatment you will have a better understanding of the complexity of the protocol you are about to undertake and the length of time it will take.

One of the problems to getting started that a significant number of people report, is what is described here as 'brain fog'. 'Brain fog' is something that may have crept up on you which makes it more difficult to understand things, make decisions, be rational, remember things. So trying to understand how Cpn makes you ill, deciphering something as complex as the Combined Antibiotic Protocol (CAPi) and knowing enough to be able to convince your doctor to support you in the treatment can be quite an undertaking. Be patient with yourself and expect to read things more than once.

Another of the difficulties you might encounter in the beginning is that you are likely to feel worse, maybe function less well and discover new areas of infection in your body that you knew nothing about. The reason for this is: when Cpn dies it releases toxins in the body which make you feel worse and may cause inflammationi that affects your ability to function. Often old injuries resurface and even areas that had not troubled you up to the present can become painful or uncomfortable. This may be particularly true of the joints of people over 40.

These worsening symptoms might well go on for several months. This can be very frightening and unsettling especially for CFSi or MS patients who might suffer from extreme fatigue or pseudo relapses. A pseudo relapse is an event that feels very much like the real thing but usually recovers without leaving any damage behind. This may happen several times during the treatment.

On the other hand you may be one of the lucky individuals who have little or no reactions to the treatment but still make significant progress.

Keep in mind that reading forum/blog posts can give you a skewed view of the difficulty of the CAP treatment, as you will see more posts from people having difficulty and needing help or encouragment than from people experiencing more mild reaction.

Progress will come slowly at first, it may be subtle and practically unnoticeable except in hindsight. Using a blog to chart your progress or keeping a diary will help to see how far you have come.

In the first few months you will gradually become accustomed to taking the antibioticsi and you may well see some notable improvements, especially if you suffer from conditions involving the upper respiratory system, such as asthmai, bronchitis, sinusitis and otitis or vertigo.

Another often reported initial improvement is body temperature. Many new patients report an inability to control body temperature: icy cold extremities that nothing will warm or repeated flushing. These symptoms often rectify themselves in the first few months.

The treatment of Cpn with an antibiotic protocol is still a work in progress and there are not enough patient experiences to be able to predict how long the treatment will go on for. What we say is that each patient has a different load of Cpn located in different parts of their body which has been afflicting them for a different length of time, so recovery will depend on all these variables and the outcome cannot be predicted. Suffice it to say that the majority of people who continue to report are noting a significant return to health. Dr. Stratton of Vanderbilt University who first formulated a treatment for Cpn suggests that a 3 to 5 years period of treatment is likely to be necessary.

I recommend that you read the Patients’ Stories section to get a feel of what people’s experience of the treatment is like.

Diseases and Symptoms Associated with Cpn.

Diseasesi and Symptoms Associated with Cpni.

The following is a partial list of diseases which research has shown that a Cpn infection maybe implicated in. There is further explanation about this association between Cpn and disease in the handbook, but this should give you an idea whether your problems may be put at the door of this particular bacterium, many patients having more than one of these diseases:

Diseases most common to Cpnhelp members	Other diseases Cpn may be involved in
Multiple Sclerosis (MS)	Alzheimer’s
Rheumatoid Arthritis (RAi)	Dementiai
Inflammatory Bowel Diseasei (IBD)	Chronic hepatitis
Interstitial Cystitisi (IC)	Systemic lupus erythematosus
Fibromyalgiai (FM)	Graves' disease
Chronic Fatigue (CF) and Chronic Fatigue Syndromei (CFSi) also called ME	Chronic inflammatory pathologies such as aneurysms
Thyroidosis	Beschet's disease
Hypertensioni	Graft versus host disease (graft rejection)
Asthmai	Haemorrhoids
Peripheral neuropathy	Ulcerative colitis
Oesophagitis	Disseminated intravascular coagulation
Sinusitis	Atherosclerosis
Arthritis	Kawasaki's pathology
Scleroderma	Coronary artery disease
Diabetes mellitus	Stroke
Sjogren's	Crohn's disease/vascular inflammatory pathologies
Sarcoidosis	Parkinson’s
Irritable Bowel Syndrome (IBSi)	Tracheobronchitis
Laryngitis, Chronic or recurrent sore throat	Chronic vascular headaches
Rosaceai	Chronic inflammatory bowel disease

Additionally some patients with Alopeciai, and Prostatitis, have reported improvements in their condition.

Treatment Protocols

Treatment

Combined Antibiotic Protocolsi

Below are a number of different protocols as recommended by Drs Stratton, Sriram of Vanderbilt University and Dr Wheldon UK consultant microbiologist. These protocols are constantly being adjusted and you might find that some patients are following a different one from you. To a certain extent the protocol you follow depends on your Cpni load, and because that is often an unknown in the beginning of treatment we recommend that you start with Dr Wheldon’s protocol (unless you or your physician have consulted a doctor familiar with the treatment of Cpn).

Wheldon Protocol

Antibiotic	Dosage	When taken	Notes
Doxycycline	100mg	Once a day	Take this alone until well tolerated.
Azithromycin or Roxithromycin	250mg 150mg	Mon, Wed, Fri Twice a day	Add either one or the other of these to the 100mg doxycycline you are already taking
Doxycycline	100mg	Twice a day	When both the above are well tolerated add another 100mg of doxycycline
Metronidazolei pulse, also called Flagyl. An alternative is Tinidazole	400mg or 500mg depending on dose available in your country. 500mg	Three times a day Twice a day	When the first two antibiotics are well tolerated start pulsing the third. For one day every three to four weeks initially. Increase the number of days per pulse gradually to five days.

When the protocol is well tolerated Doxycycline and Azithromycin (or Roxithromycin) are taken continuously as outlined above. They prevent Cpn from replicating as well as killing it slowly (these antibiotics are called bacteriostatic antibiotics). After three or four months of these two antibiotics you can start pulsing the third antibiotic.

Definition of a pulse: Think of a cycle of treatment as a period of time. How long that period is depends on how well you are coping with the Combined Antibiotic Protocol (CAPi), usually this cycle is three or four weeks long. Once during this period of time you take Metronidazole (or Tinidazole) for a period of up to 5 days at the full dose. In the beginning of your treatment the pulse may be only one day long, as you tolerate the CAP you can increase the number of days you take the Metronidazole. Well into the treatment you may want to increase the number of days you take Metronidazole (or Tinidazole) beyond the 5 days recommended.

The reason behind a pulse is that Metronidazole or Tinidazole are the killer antibiotics (called bactericides) and when Cpn dies it releases toxins into your blood that your body has to process. This pulsing allows your body to recover and makes the treatment more bearable. Too much bacterial kill at one time is overwhelming to the body. Dr Wheldon regularly revises his protocol and it is worth visiting his website for the latest information.

Sriram Protocol

Antibiotic	Dosage	When taken	Notes
Rifampin	150mg	Twice a day	Take this on its own for two weeks or as tolerated
Azithromycin	250mg	Mon, Wed, Friday	Take this together with Rifampin for the duration of the treatment
Metronidazole	400mg or 500mg	Three times a day	Start taking this a month into the treatment and take it for 15 days on 15 days off for the duration of the treatment.
Sodium or Calcium Pyruvate	4 to 6g	about an hour before antibiotics (twice a day)	Start this 8 weeks into the treatment.

Rifampin is a very effective killer of RBs (Reticulating Bodies) and therefore it may take a while to feel comfortable taking it. It may take longer than the two weeks suggested in the chart. It is also worth noting that Rifampin can affect the efficacy of other drugs you may be taking such as Thyroxine for example. It may also cause your liver enzymes to become elevated and for that reason you should be closely monitored by a doctor.

In this protocol Metronidazole pulses are 15 days long. This may well be very difficult to sustain and in that case patients have been advised to reduce the pulse to 7 days in 21.

Stratton Protocol

The Stratton protocol starts off in the same way as the Wheldon Protocol. However the aim is to build up to a point where you are taking all three antibiotics (ABXi) continuously. Once you have achieved that you add:

Antibiotic	Dosage	When taken	Notes
Rifampin	150mg	Twice a day	Build up as tolerated
INHi	300mg	Once a day	Pulsed with metronidazole or daily

Recommended Supplements

Recommended Supplementsi

As well as the antibiotics (ABXi) our bodies need these supplementsi to help them recover from the effects of Cpni, the ABXi and the toxins. The most important of these is N-Acetyl Cysteine (NACi). It supports the liver which is going to be doing some hard work during this treatment but more importantly it causes the EBs (Elementary Bodies) to burst open before they have a chance to infiltrate a cell. So it has a direct action on Cpn.

Supplements

Supplement	Dose	When taken	Notes
NAC	600 to 1200mg	Twice a day	Build up gradually, can cause heartburn
Vitamin C	1g	Once a day
Vitamin E	800iu	Once a day
Omega 3 Fish Oil	400mg	Up to three times a day
Evening Primrose Oil	1g	Once a day
Acetyl L-Carnitine Alpha Lipoic acidi	500mg daily 150mg	Once a day	Combination available
Co-enzyme Q10	200mg	Once a day
Selenium	200 micrograms	Once a day
Turmeric	400mg	Once a day	Can help alleviate toxin reactions
Melatonini	1.5mg	At night	If needed for sleep
Vitamin D3	2000iu	Work up to twice a day	Has antibiotic properties, may cause some die off symptoms
Vitamin B12	4000 micrograms	Several times a day	Sublingual lozenges. After three months of treatment once a day.
Lactobacillus acidophilus	1g	Twice a day	Not to be taken within two hours of antibiotics
Vitamin B complex		Once a day
Calcium Magnesium	500mg 300mg	In the evening	Usually found in combination. Not to be taken at the same time as Doxycycline.

The bold supplements are considered the ones that are essential; on the whole these are fairly inexpensive. But if you can afford it you should aim at taking at least the complete list.

There are other supplements that you may be used to taking or that your doctor may recommend so this is not an exhaustive list. There is more information on supplements here. There is more information on antifungals and probiotics here.

Reactions and Remedies

Reactions

When you start a Combined Antibiotic Protocol (CAPi) you may get a number of different reactions. Here is a chart of possible issues and followed by some remedies that might help alleviate the discomfort.