Protocols

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Treatment protocols for Chlamydia Pneumoniae, usually using combination antibiotics.

Dr. Michael Powell: A Rheumatologist Treating Cpn in CFIDS, FM, Lupus and other "auto immune" disorders

I spoke with a rheumatologist in California, Dr. Michael Powell, who is cautiously using a combination of antibioticsi in conjunction with standard therapeutics for the treatment of nanobacterium (including Cpni) in patients suffering from FM, CFSi and autoimmune disorders. His results with this treatment program have been encouraging. He faxed me some examples of patient feedback forms, excerpts from which you can see below. Recovery is not instantaneous, but tends to occur over a 6 to 12 month period. The graphs of subjective improvement are drawn from visual analogue scores compiled during each visit. When summarized in this manner these data give a time-lapsed impression of the response to treatment.

One of the interesting things he mentioned was in relation to negative patient serologyi for Cpn when other clinical signs lead him to suspect some involvement. Serologic assays for IgGi, IgM and IgA are sent to confirm infection prior to treatment. He would like to see a positive serologyi in patients before engaging them in a combination antibiotic protocol, but recognizes that patients may not have antibody reactions. This may be due to the ability of intracellulari organisms like Cpn to evade a humoral response (antibody production), immunoglobulin depletion, or other factors. In these cases, when there is a high index of suspicion for the infection without a humoral response, he tests the spouse of the partner for Cpn. He sees the "non-symptomatic" partner as a good indicator of Cpn in the patient, given the infectious nature of Cpn. Thus far, most spouses are positive when an ill family member is non-reactive.

In our discussion Dr. Powell pointed out the many similarities between TB and Cpn.  Both organisms  can evade our immune system.  Both organisms can be carried from the lungs, the original site of infection, and infect other tissues. Both require prolonged treatment with multiple drugs to eradicate the infection.  Both are sensitive to stress levels. Optimal therapy is being evaluated at various research centers and new medications for Cpn are on the horizon (see activbiotics.com).

INHi and supplementsi for endotoxinsi-
Dr. Powell finds most patients improve on a standard combination antibiotic protocol for Cpn. Rheumatologist have apparently been using doxycycline for many years with success for inflammatory arthritis but there is evidence that using doyxcycline in combination with rifampin is even more effective. Some patients plateau after about 8 months of treatment he has found variations in the treatment protocol have made a difference. One protocol he uses involves the use of NACi 600 mg twice daily, INH 300 mg once daily before breakfast, and metronidazolei 500 mg twice daily pulsed with 5 days on and two weeks off.  It is essential to start each agent separately and gradually increase the dose over weeks or months as tolerated.  The use of Vitamin C 500 - 1000 mg four times daily (the half life of vitamin C is 30 minutes and little remains after 3 hours) to offset the release of toxins during therapy.  B6 is important to control INH related peripheral neuropathy.  Monthly laboratory evaluation of AST, ALT, Cr, and CBC are recommended for all who engage in this protocol.  It is not uncommon for liver enzymes to show a mild elevation during the initial stages of treatment.  Antibiotic therapy should be temporarily discontinued during periods of toxicity, should it arise. He emphasized the importance of insuring that yeast and fungal infectionsi do not overgrow during protracted antibiotic use. He recommends the use of acidophillus, nystatin, diflucan, oregano oil, and/or grapefruit seed extract as needed to prevent secondary opportunistic infection during treatment.

Covering for the possibility of yeast and fungal overgrowth during antibiotic therapy is essential.  If diarrhea develops, stool must be evaluated for antibiotic associated diarrhea (C. difficile).  This is not a simple protocol and it is best if it is guided by an experienced clinician who is familiar with the medications and methods of minimizing toxicity related to killing the nanobacterium.

A link to Dr. Powells clinic may be found on our links page. Dr. Powell does do telephone consultations by arrangement and may be a resource for those who have had difficulty finding a Cpn knowledgeable doctor in their area. He requires an initial visit with a physical examination before initiating therapy (lab work can be performed prior to the initial visit to facilitate diagnosis and treatment), and monthly laboratory testing with monthly phone consults are then the norm. Treatment of related hormone imbalances in the thyroid system and nutritional support, temporary antidepressant support as needed, and sleeping medications are useful adjuncts to the antibiotic protocol. It is necessary for patients to have a primary care physician to monitor health matters that are unrelated to FM, CFS and autoimmune disease.

Comparing the Antibiotic Regimens

As people get into more of the information about the combination antibiotic (abxi) protocols on this site, confusion can arise about what medications are used with which protocol, and even which version. In the interests of clarity, I will try to summarize and compare the 7th Stratton/Vanderbilt protocol (published on this site), the most recent version of it represented by the interview with Dr. A, and David Wheldoni's most current regimen. Drs. Stratton and Wheldon have graciously replied with their overviews of protocol variations.

Wheldon Regimen:

  1. Doxycycline 200mg once a day (working up to this dose as the patient can manage)
  2. Then adding Roxithromycin (not avail in USA) 150mg twice a day OR Rifamcini 300mg twice per day OR Azithromycin 250mg three times per week (working up to this dose as the patient can manage)
  3. After 2-3 months or when the patient experiences little reaction from this dual abxi combo metronidazolei (Flagyl) is added (tinidazole may also be used if better tolerated). First a single 400mg (it comes in 500mg in the USA) is tried for the first pulse. Then every 3-6 weeks depending on tolerance a pulse of this is done working up over time to 400mg three times a day for 5 days.

When metronidazole pulses yeild no further reactions or improvements, the goal is to do 2 week courses of the abx, with days 5-9 being also Flagyl pulses. 

Cpn Treatment Information

The links below will take you to pages with specific information involved in the treatment of Cpni.

Diagnostic Testing For Cpn<
Information on serological testing and the problems of this in Cpn.
Combination Antibiotic Treatment Protocols for Cpn<
Links to pages on the current versions of Vanderbilt/Stratton and Wheldon Protocols for treating Cpn infectionsi in various diseasesi.
Experts Comments<

Commentary and interviews  with various experts in treating Cpn which help guide and inform about various facets of treatment.
Treatment Reactions<
Information on some of the kinds and sources of treatment reactions one can expect on combination antibiotic protocols in treating Cpn, including cytokinei reactions, endotoxini reactions, secondary porphyriai and other reactions. These are often lumped under the term "herx," an inaccurate term and not as useful as really understanding what's going on.

 

Surveys on Treatment Experiences

The first survey is now closed!

The results can be found at <HERE< 

Thanks to everyone who participated!


The current Cpni CAPi Treatment Survey can be found at this link< and taken by anyone engaged in doing a CAP.

Comments by David Wheldon in response to questions about choice of antibiotics in his protocal versus the Vanderbilt protocal:

I believe that Stratton and co-workers used a beta-lactam (penicillin, amoxycillin or similar) to attack the infectious stage
(elementary body) of the organism. They did some in vitro work to support this, which they should publish, because it's
fundamental. I reasoned that, as culture was so rare in persistent human infections, the numbers of elementary bodies would
be small. Also, any elementary body entering a phagosome in a cell containing bacterial protein-synthesis inhibitors would be
doomed, as the organism needs to fabricate proteins immediately to survive. Coupled with this was a native gut-reaction that
people would buy into the idea more readily if there were fewer antibiotics. And, further, that one is taught at med school
never to combine cidal and static agents. In the higher levels of microbiology that's not always true, but basically you just
want people to believe you and treat, as early as possible, and the more complications you put in their way the more difficult
that is.

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