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Combined antibiotic cure my experiences with Lyme borreliosis since 1984

Bózsik, Béla Pál, M. D. & the Therapeutic Workgroup,
Head: Professor Feher, J. Members: Bozsik,B.P.- Csoma, E.-Eszto, K.- Hollosy, A.- Ory, K.- Pornoi, A.- Schleer, M.- Timmer, M.;

Lyme Borreliosis Foundation,
HUNGARY

The best opportunity to fulfill our medical oath is close at hand: „Salus aegroti suprema lex esto”
The well-being of the patient is the most important law, really.
The best example could be Lyme borreliosis: it is endemic, its causative agent is known, it could be determined, its pharmacy is known, so, it is curable.
Lyme borreliosis has been known since the ancient times when Man was in close contact with nature. Scleroderma was described by Galenus.
Endemic Lyme borreliosis
Was estimated to affect AS much as 10 % of the population at least.
Because of problems with diagnosis and differential diagnosis, there is no exact epidemiological data Due to problems with therapy and the long persistence of infection, patients accumulate in the population
The WORLD of The causative agent of Lyme borreliosis
The Phylogenetic tree
The genetic plasticity of Borrelia burgdorferi sensu lato gives it the possibility to change its character Both in nature & Within the body during the whole disease process.
The causative agent of Lyme borreliosis is sensitive to several well known antibiotics.
Therefore, One might assume that it is easy to cure. However, for this to be true, one needs a firm diagnosis.
It is time we reevaluated our view on SYNDROMES
The uncommon clinical picture of Lyme borreliosis develops as a result of macromolecular immune complexes. Major and minor symptoms undulate,
TREATMENT MAY IMPROVE THE SYMPTOMS OF Lyme borreliosis, WHILE LEAVING OTHER CONDITIONS UNAFFECTED!

It is the time to reevaluated our opinion on DIAGNOSIS

Epidemiologic or Academic principles -in some relation need culture positivity and/or „two tiers” determinations- could fail the patients with negative ELISA as they will not undergo Western-blot testing. Some tend to forget that although these are good scientific tools, we should not think more of them.
Once again beware:“Only 64% of the patients met the surveillance case definition for Lyme disease.” (JAMA 2002) –
so, at least 36% of the sufferings were missed.

Insurance medicine principles of diagnosis
it missed their original idea about the socialised medicine & helping people in distress and rising the level of common health:
covers expensive investigations,
accepts wheel chair, but from inexplicably cause
refuse serologic investigations and/or
antibiotic treatment(s) all over the world.
Disability of even the young and the most progressive people of the society is accepted & provided, for while proper serologic Investigations & treatments are not cover.
Therefore, missed cases of Lyme borreliosis also place an economic burden on society.

American College of Physicians stated: the diagnosis of Lyme borreliosis depending on epidemiological and clinical data reported from the patients – it is really founded the basic principles of the consultative diagnosis. Despite this statement stopping short of accepting the possibility of seronegative cases, for instance, it did introduce clinical consultation Into the process of making the diagnosis.

This gets us close to what the evaluation process should be like in my view.
Patient-centered principles of diagnosis & care based on the latin proverb, on which the medical practice should be founded: Salus aegroti suprema lex, esto. — "The well-being of the patient is the most important law, really."
The well-being of the patient, providing this well-being & making scientific development is the best goal, which may be expressed as follows:
Evidence Based Medicine in Lyme borreliosis should involve five years follow-up practice in each case, as it is in every Spirochetosis.
Special possibility of the patient-centered diagnosis based on the confidential collaborations & consultation: Ex iuvantibus diagnosis,
which is part of the ART OF MEDICINE: DECISION-TREATMENT-FOLLOW UP-DECISION According to the clinical picture!

Thinking again the DIAGNOSIS The Summary
My remarks: –
Making the appropriate diagnosis relies more & more on laboratory determinations –
Indicating the treatment & developing the schedule left to clinical science –
Follow up patients both of them.
Recommend the followings questions:
Can you retain that tick(s) for analysis?
Has Lyme-spot developed on body any time?
Where were they located geographically and anatomically?
Did the signs fluctuate?
How long was the cycle of fluctuation in weeks time?
Were you or could you bitten by a tick?

B Burgd lifecycle is at least 3 weeks reflected by periodic reappearance of symptoms headaches and artgralgy, in this seropositive patient.
Unit time 2-3 weeks
Unit time for cure 4-6 weeks
The required DURATION of the treatment can be established as 4-6 weeks or more.
Informations is needed regarding previous treatments with antibiotics:
This is the so-called ANTIBIOTIC CASE-HISTORY.
THE THERAPEUTIC SCHEDULE ALSO BASED ON THIS INFORMATION.
There are no clear-cut ending of the symptoms, therefore could not applied the old rule: Abx treatment continues up to disappearing the symptoms+3days
The Summary of DIAGNOSIS - The Consequence
199 of 960 patients were misdiagnosed, and given incorrect treatment.
Which antibiotic should be prescribed
On the Stockholm Conference (1st with Lyme borreliosis term) there were fiery debate for and against the two basic antibiotics:
PENICILLIN & its derivatives
DOXYCYCLINS, and
FLUOROQUINOLONS were postered to have no effect on Borrelia
ERYTHROMYCINS have no effect in our practice:
Having realized this situation the only option was to investigate combinations of abx with other one, which is registered & proven to be effective against Borrelia
In vitro effects of antibiotic combinations
Pefloxacin and Doxycycline - Synergistic effect on doxycycline: HUNDRED times
Pefloxacin and Ceftriaxon - Synergistic effect on ceftriaxon: TEN times
The excessive synergism noted shed light on the importance of DNA-gyrase in Borrelia with plastic genetic material & good adaptation to any environment.
Fibroblasts protected B. burgdorferi for at least 14 days of exposure to ceftriaxone. … several eu-karyotic cell types provide the Lyme disease spirochete with a protective environment contributing to its long-term survival. Ceftriaxone, Borrelia burgdorferi, Cultivation, in vitro, fibroblast, protection _ Klempner et al J-Infect-Dis. 1992
Borrelia b.persisted inside synovial cells for at least 8 weeks. _Girschick-HJ et al 1996
Intracellular(!) Borrelia to be destroyed it needs as much abx as twenty quantity of MIC
Doxycycline in a dose of 200 mg/day does not produce effective concentrations in CSF: The dose of DOXYCYCLINE is 300 to 400 mg a day

The prerequisites of effective therapy

Prevent changes in the genetic material, an indication for using ciprofloxacine, while
Inflict damage on the cell wall generation or metabolism (with the antibiotic case history in mind) in order to kill all spirochetes, including those intracellularly and in the brain.
This is the summary of my hypothesis formed in 1990, and later verified in vitro and at the bedside.
The keys to effective treatment?
First, prevent adaptation fluoroquinolones
Second, develop an individualized therapeutic schedule based on the antibiotic dinamics &antibiotic case history
Third, determine sub-strain(s) to aid the develop-ment of an individualized schedule:
B.afzelii: doxycylin,
B.burgd.s.s.: clarithromycin
B.garinii: penicillin & its derivatives
For this reason there is good chance with
PCR: from TICK(removed/regional), patients’ samples
Wb: concentrated(half of the working dilution) samples to recognize the substrain(s)
Approved schedule - for individual prescription
Ciprofloxacine 3 x 250 - 500 mg/die
At the same time prescribed:
Doxycycline 3 x 100 - 2 x 200 mg/die
Clarithromycin 3 x 250 - 500 mg/die
Josamycine 3 x 500 - 1000 mg/die
Ceftriaxone I.V 1-2 X 2000 mg/die
Clarithromycin I.V. 3 x 250 - 2 X 1000 mg/die
Doxycycline I.V. 2 x 200 - 400 mg/die
In combination for individual application
Several periods of 3-4 weeks
Supplemented vitamins and trace elements
Supporting immune systems, rehabilitate spirit and body
Autoaggressive & seronegative LYME BORRELIOSIS
Myasthenia Gravis syndrome
Clinical evidence of immunocomplex-mediated damage With infective origin to the neuromuscular junction end-plate flattening decreased signal transduction

17 yr old professional sports-woman (dancer) Numerous tick-bites in Sept 1999 but no ecm vertigo, polyneuritis 1st WB: lyme borreliosis (Dr.lakos) rocephin 2g/die for 11 days school-acquired infection on the 10th day, 07.12.1999 gradual improvement, another infection myasthenia begins in feb 2002 myasthenia crises (4x) Mestinon, medrol+imuran, plasmapheresis gastrostoma oct and nov 2001 WB_seronegative positive microscopy result Dg:autoagressive lyme borreliosis two different medical conditions or complicated LB 1st Wb & 4th (feb 2003) seropositivi-ty with newly developed kit supported by the result of pcr (B.burg.s.s)

therapeutic schemes & considerations

In the classical sense
Lyme borreliosis was cured or is disregarded in the pathogenesis of severe Myasthenia gravis
discontinuation of steroid therapy may extend the length of crises or even lead to death:
recommended therapy/prevention for severe Myasthenia gravis:
MEDROL/IMURAN (40MG daily for a year in this case)
PLASMAPHERESIS
Gammaglobin i.v.
pathogenetically
therapeutic dilemma medications used in the treatment of lb contraindicated in myasthenia, - drugs used for myasthenia may exacerbate Lyme borreliosis .
therapy: ceftriaxon 2g BID plus ofloxacin 200 mg BID,
followed by Doxycycline 200mg BID,
Liver damage!
followed by Clarithromycin 150mg QID then 500mg BID,
Psychotherapy
treatment for 24 weeks
„Orsi became weaker during the first 8 days of treatment but fortunately her breathing was not jeopardized. she had pain in her muscles, joints and lymph nodes and she chilled with fever. Her joints became floppy. she started to get better on the 10th day, and by now she can walk considerable distances with assistance. She can also swallow better, and her balance has improved, as well. “
Clinical solution (?):
further evaluation home & abroad,
avoid abx for fear of side effects,
discontinue steroids & endanger the patient
or disregard the opinion stating: it is a case of myasthenia that has nothing to do with the previous Lyme borreliosis
Autoaggressive seronegative LYME BORRELIOSIS after 24 weeks of treatment with antibiotics
In may 2003 she left the wheelchair After 3 years in it family happy– society satisfied– hypothesis proven

Some of Our Cases with Lyme Borreliosis Seronegativa

Av block: treatment with antibiotics instead of a Pacemaker. pt later became a professional sportsman (water polo) again
Carditis & myelosuppression: following treatment with ineffective antibiotic (Rocephin); _improvement after 1 week treatment with effective antibiotic (Tienam) & complete recovery after 4 week treatment with effective antibiotic (Tienam); weight loss (16 kg) after the discontinuation of steroid therapy. reoccurring lb was denied to treat abx: she died after the reinstituting of steroid therapy.
She was a 27 yr old medical student about to complete her studies
facial Paresis: unwarranted (?!) treatment with antibiotics– pt, she was a model, recovered quickly and completely
Raynaud’s syndrome: symptoms worsened by heat _improved after treatment with antibiotics (lancet, 1990)
familial Lyme borreliosis : mother has RA at the age of 18, daughter has anosmia, son has ptosis; all three of them get better after treatment with antibiotics anosmia congenitalis milder!
Rheumatoid arthritis: After 2 yrs of standard therapy the diagnosis of Lyme borreliosis is made: pt he can ride the bicycle a country-tour & play tennis after treatment with antibiotics
Rheumatoid arthritis: _5 yrs of pain after ineffective antibiotic therapy (rocephin); complete recovery following effective antibiotic therapy (doxycycline IV.)
Guillon-barré syndrome: treatment before surgery full recovery treatment after surgery sustained paresis
Multiple Sclerosis syndromes (LB_labor – MS_clinical: without therapy: wheelchair with therapy: no wheelchair, university student
What could be done for the more effective treatment?
Modern possibilities for FEVER therapy far-infra-red saunas with 10 nm irradiation
Krętka

Posty: 63
Dołączył(a): 7 wrz 2009, o 23:05