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Dr. Burrascano gyógyszerprotokolljai

2015.04.11

Dr. Burrascano protokollja:

Benzathine Penicillin

Összehasonlító tanulmányok, melyeket a Columbia Egyetemen végeztek kimutatták, hogy a parenterális terápia előnyt élvez (előnyösebb) a szájon át szedett terápiával szemben krónikus betegeknél. A lehetőségek: izomba adott hosszú hatóidejü penicillin G (vagy más néven benzathine penicillin vagy Bicillin-LA) vagy intravénás antibiotikum.

Egy penicillinekhez tartozó gyógyszernek a gyógyszerszintet 72 óráig fent kell tartani, hogy hatékony legyen. A bicillin LA egy olyan formula ami megfelel ennek a kritériumnak. Az eddig lyme-kórt kezelő orvosok által publikált tanulmányok alátámasztják ennek a gyógyszernek a hatékonyságát, biztonságosságát és hasznosságát egyaránt. Sok páciensnél hatásosabb ez a gyógyszer, mint a szájon át szedett gyógyszerek, és a hatásossága az intravénás terápiával közel megegyező, amennyiben a dózis megfelelően magas.

Általában heti 3-4X kerül beadásra, és a terápia hossza 6-12 hónap körül mozog. Az előnye, hogy nem túl drága, mentes a bélrendszeri mellékhatásoktól, nem valószinü, hogy gombás fertőzést okozna, és nagy a biztonsági foka már így több évtized elteltével is. Ami még szintén előnye, hogy a családtagok is megtaníthatóak az otthoni beadásra, amit így otthon lehet beadni.

Adagolás: alacsony adagolással kell kezdeni, mert hosszú, elnyújtott 6 vagy több hétig tartó Herxheimer reakció várható.

Felnőtteknek: 1.2 million U- three to four doses weekly. (heti 3-4X 1,2 egység)

Gyerekeknek: 1.2 to 3.6 million U weekly.

Terhesség alatt is adható.

Ceftriaxone kezelés: Azoknak a betegeknek, akiknek súlyos, hosszú ideje fenálló betegsége van a borrelia burgdorferi miatt, annak ellenére hogy korábban olyan antibiotikus kezeléseket kaptak melyek más, kevésbé beteg egyéneknél gyógyulást hoztak. Korábban már több cikk és tanulmány is leírta a hosszan fennálló betegség okát. Ezeknek több oka van, pl. a lymphocytákban való elrejtőzés képessége, különféle alakok felvétele (ciszta stb.), alvó kórokozó stb.

Egy sikeres megközelítést súlyosabb állapotú betegeknél először a 90-es évek elején publikáltak, ahol magas adagolású ceftriaxone-t adtak pulzáltatva. Azóta még több olyan tanulmány született, melyek ezen feltételezések helyességét igazolják.

A dózis ceftriaxone esetében 4 gramm naponta - lehetséges napi kétszer 2 g adagolásban, vagy 4 gramm napi egyszer beadva, lassan csöpögtetve, 4 egymást követő napon keresztül, általában 14 héten keresztül, vagy ennél hosszabb ideig. Ez az adagolás biztosítja a legnagyobb hatákonyságot, és csökkenti a hosszú távú antibiotikus terápia szövődményeinek lehetőségét is.

 

CEFTRIAXONE TREATMENT A subset of patients who have severe, longstanding illness due to Borrelia

burgdorferi carry persistent infection despite having previously received antibiotic treatments which have

eliminated the disease in less ill individuals. The mechanism for such persistence has been the subject of

many peer reviewed articles. They include persistence of B. burgdorferi in protective niches, inhibition and lysis

of lymphocytes, survival in phagocytic vacuoles, antigenic shifts, slow growth, shifting into alternate forms, and

dormancy and latency.

One successful approach in the more ill patient, published in the early 1990s, is to use higher doses of

ceftriaxone in a pulsed-dose regimen. Since then, clinical experience has expanded upon this concept, and at

the MLDA Lyme Congress in September, 2002, Cichon presented data on a pulsed, high dose regimen which

supports and refines this concept. This regimen is now considered the current standard of care in the use of

ceftriaxone.

Treatment with ceftriaxone is dosed at 4 grams daily- given either as 2 grams IV twice daily, or 4 grams slowly

once a day, four days in a row each week, usually for 14 or more weeks. Such a regimen is not only more

effective in the Chronic Lyme patient, but regular interruptions in treatment lessen the potential complications of

intensive antibiotic therapy with ceftriaxone, such as biliary sludging and colitis. Hence a more effective, safer

regimen that by virtue of the treatment breaks, is less costly and affords the patient a more acceptable lifestyle.

IV access with a heparin lock becomes possible (and preferred).

 

BENZATHINE PENICILLIN Comparative studies published by Fallon et. al. at Columbia University have shown

that parenteral therapy is superior to oral therapy in chronic patients. Options include intramuscular long acting

penicillin G (benzathine penicillin, or “Bicillin-LA”) or intravenous antibiotics.

For an antibiotic in the penicillin class to be effective, time-killing curves show that significant levels of antibiotic

must be sustained for 72 hours. Bicillin LA is a sustained release formulation that meets these criteria.

Published studies in children and adults, combined with over a decade of experience with this therapy by front

line, Lyme-treating physicians have established the efficacy, safety and usefulness of this medication. In many

patients it is more effective than oral antibiotics for treating Lyme, and compares closely to intravenous therapy

in terms of efficacy if the dose is high enough.

It is usually administered three or four times weekly for six to twelve months. It has the advantage of being

relatively inexpensive, free of gastrointestinal side effects, unlikely to promote the overgrowth of yeast, and has

an excellent safety record spanning many decades.

Finally, an added plus is that family members can be trained to administer this treatment at home.

 

Benzathine penicillin- Surprisingly effective IM alternative to oral therapy. May need to

begin at lower doses as strong, prolonged (6 or more week) Herxheimer-like

reactions have been observed.

Adults: 1.2 million U- three to four doses weekly.

Adolescents: 1.2 to 3.6 million U weekly.

May be used in pregnancy.

Benzathine penicillin- Surprisingly effective IM alternative to oral therapy. May need to

begin at lower doses as strong, prolonged (6 or more week) Herxheimer-like

reactions have been observed.

Adults: 1.2 million U- three to four doses weekly.

Adolescents: 1.2 to 3.6 million U weekly.

May be used in pregnancy.

 

NUTRITIONAL SUPPLEMENTS IN DISSEMINATED LYME DISEASE

BACKGROUND INFORMATION

Studies on patients with chronic illnesses such as Lyme and Chronic Fatigue have demonstrated that some of

the late symptoms are related to cellular damage and deficiencies in certain essential nutrients. Double

blinded, placebo controlled studies, and in one case direct assay of biopsy specimens have proven the value of

some of the supplements listed. Some are required, while others are optional -see below. They are listed in

order of importance.

I suggest patients use a pill organizer. These are multi-compartment boxes that you pre-fill with your pills once

a week. This makes the task of taking a large number of tablets much, much simpler and can markedly

minimize missed doses. The Vitamin Shop sells a variety of good organizers.

I have found that the quality of supplements used is often more important than the dose. In fact, I do not

recommend “mega doses”. Instead, seek out, if possible, pharmaceutical grade products, especially if USP

certified. I recommend, among others, Pharmanex, Researched Nutritionals and Nature Made products

because they fit these criteria. In the list below, it is indicated whether the products should be gotten from

Pharmanex, Researched Nutritionals, a different specific manufacturer, or even if a generic substitute is OK.

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To order products from Pharmanex, users need to register as a customer with a referral from another registered

customer. You may use my referral number (US9256681) to get started. Call 1-800-487-1000.

To order products from Researched Nutritionals, patients will need a physician’s referral. If you do not have your

own account, you may use my name when ordering. Call 1-800-755-3402.

Nature Made products are widely available in vitamin stores and pharmacies.

BASIC DAILY REGIMEN (in order of importance)

1. PROBIOTICS (required when on antibiotics)

Kefir: This is a yogurt-like drink that is said to more permanently replenish beneficial flora. It is only necessary

to drink 2 to 4 ounces a day.

Acidophilus: the best kinds are frozen or refrigerated to ensure potency. Usual dose is two with each meal.

Plan to mix together several different brands to broaden the spectrum. Acidophilus can be gotten from most

vitamin stores but some generic brands are of unknown freshness and potency. An alternative that does not

need refrigeration and can be taken only once a day is a high potency, patented product called “Pro Bio” from

Pharmanex. The ultimate mix of pre- and probiotics with soil based organisms is a product called “Prescript-
Assist Pro” from Researched Nutritionals. This too does not need refrigeration.

In addition, have 4 ounces of sugar-free yogurt on occasion.

2. MULTI-VITAMIN (required)

I recommend the Life Pack family of multivitamins available through Pharmanex. These are unique

supplements- pharmaceutical grade and USP certified, they are the only products clinically proven in double

blinded, placebo controlled crossover studies to quench free radicals and raise antioxidant levels in the blood

and lipids. Choose LifePak for males under 40, LifePak Women for hormonally active women, LifePak Prenatal

when pregnant, and LifePak Prime for postmenopausal women and for men over 40. LifePak Teen is also

available. Continue long term.

3. CO-Q10- required, but do not use while taking the prescription drug atovaquone (Mepron, Malarone).

Deficiencies have been related to poor function of the heart, limitations of stamina, gum disease, and poor

resistance to infections. Heart biopsy studies in Lyme patients indicated that they should take between 300

and 400mg daily. I recommend the Co Q-10 from Researched Nutritionals. One caplet contains 400 mg, so the

dose is one a day with food.

4. ALPHA LIPOIC ACID (required)

This facilitates entry of CoQ-10 into mitochondria. Dose is 300 mg twice daily. Generic is OK.

5. VITAMIN B (required).

Clinical studies demonstrated the need for supplemental vitamin B in infections with Borrelia, to help clear

neurological symptoms. Take one 50 mg B-complex capsule daily. If neuropathy is severe, an additional 50 mg

of B-6 can be added. Generics are OK.

6. MAGNESIUM (required)

Magnesium supplementation is very helpful for the tremors, twitches, cramps, muscle soreness, heart skips

and weakness. It may also help in energy level and cognition. The best source is magnesium L-lactate

dehydrate (“Mag-tab SR”, sold by Niche Pharmaceuticals: 1-800-677-0355, and available at Wal-Mart). DO

NOT rely on “cal-mag”, calcium plus magnesium combination tablets, as they are not well absorbed. Take at

least one tablet twice daily. Higher doses increase the benefit and should be tried, but may cause diarrhea. In

some cases, intramuscular or intravenous doses may be necessary.

7. ESSENTIAL FATTY ACIDS: (required)

Studies show that when EFAs are taken regularly, statistically significant improvements in fatigue, aches

weakness, vertigo, dizziness, memory, concentration and depression are likely. There are two broad classes:

GLA (omega-6 oils) and EPA (omega-3 oils), derived respectively from plant and fish oils. This is what to take:

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Plant Oil: Use a refrigerated liquid product of mixed omega oils obtained from the local health food

store (always avoid capsules as the plant oils within may be rancid and you would never know). Take

one to two tablespoons of the liquid oil daily. May be mixed with food, put on salads, etc.

Fish Oil: Use “Marine Omega” by Pharmanex. Use four daily, taken on a full stomach (this brand is

required because it is made not from fish, but from Krill and is certified to be free of any measurable

amounts of heavy metals and organic toxins).

8. NT-FACTOR

This product addresses the mitochondrial damage thought to underlie the metabolic dysfunction associated

with chronic diseases which, in patients with tick-borne illnesses, is manifest by fatigue and neurologic

dysfunction. It is the single most reliable agent I have found that can give noticeably increased energy levels.

When supplements known to support neurological function are added (see below), improved cognition and

memory often result. Effects will be noted in two to three weeks. It also contains high quality prebiotics and

probiotics. Available from Researched Nutritionals.

OPTIONAL SUPPLEMENTS FOR SPECIAL CIRCUMSTANCES

FOR NEUROLOGIC SYMPTOMS- here, the goal is three-fold- supply the metabolic needs, replenish

what has become depleted, and protect the neurons and their supportive cells. The “required”

supplements, above, must be taken, and the items that follow below are considered “add-ons”.

ACETYL-L-CARNITINE- this is taken along with SAM-e. This combination can result in noticeable gains in

short term memory, mood and cognition. The Acetyl Carnitine also is said to help heart and muscle function.

Doses: Acetyl-L-carnitine- 1500-2000 mg daily on empty stomach; SAM-e- 400 mg daily with the acetyl

carnitine. Positive results may appear as early as 3 weeks; use for 2 to 3 months, but repeat or extend this

course if needed. Available in most vitamin stores; Generic acetyl carnitine is okay, but I recommend “Nature

Made” brand SAM-e (also available at most vitamin stores).

METHYLCOBALAMIN (Methyl B12)

Methylcobalamin is a prescription drug derived from vitamin B12. This can help to heal problems with the

central and peripheral nervous system, improve depressed immune function, and help to restore more normal

sleeping patterns. Many patients note improved energy as well. Because the oral form is not absorbed when

swallowed or dissolved under the tongue, Methyl B12 must be taken by injection. Dose is generally 25 mg. (1

c.c.) daily for 3 to 6 months. Long term studies have never demonstrated any side effects from this drug.

However, the urine is expected to turn red shortly after each dose- if the urine is not red, a higher dose may be

needed or the present supply may have lost potency. The injectable form of this is not available in regular drug

stores. It must be manufactured (compounded) by specialty pharmacies on order.

GREEN TEA

Green, but not black or white tea contains some of the most potent antioxidants around (80-100 times more

effective than vitamin C). I strongly recommend this to any patient with degenerative changes to the central

nervous system. At least four cups daily are needed to reap this benefit, and the tea must be decaffeinated. A

nice alternative is “TeGreen“ capsules by Pharmanex. They contain 97% pure tea polyphenols and each

capsule is the equivalent of four cups of decaffeinated green tea. Take one to three daily.

CORDYMAX

Cordyceps is a well-known herb from Tibet that has been shown in clinical studies to improve stamina, fatigue,

and enhance lung and antioxidant function. It also raises superoxide dismutase levels, important to prevent

lesions in the central nervous system, which is why this (along with green tea) is essential if neurodegeneration

is part of your illness. The positive effects can be dramatic; should be used long term. USP- certified cordyceps

is available from Pharmanex as "CordyMax".

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CITICHOLINE

Many studies have shown benefits to cognition, especially memory. Benefits are slow to notice, so plan to use

this long-term. Dose is 500 to 1000 mg twice a day.

FOR IMMUNE SUPPORT

“REISHI MAX “

This enhanced extract from cracked spores of the Reishi mushroom has been shown in clinical studies to

augment function of the Natural Killer Cells as well as macrophages. Recommended in all patients who have a

CD-57 count below 60. Take four a day. Available only from Pharmanex.

TRANSFER FACTORS are the body’s natural signals meant to activate the pathogen-killing effects of the

cellular immune system. Therapy with these agents consists of taking both a general stimulator, plus specific

transfer factors for the infection you have. Personal experience made me a believer in transfer factor therapy.

For Lyme patients, use Transfer Factor Multi-Immune as the general stimulant, and Transfer Factor Lyme-
Plus as the specific agent. Both are exclusives from Researched Nutritionals, and I have found them to be

surprisingly effective in making the very ill respond better to treatment. Take as directed on the label.

FOR JOINT SYMPTOMS

GLUCOSAMINE

Glucosamine can be of long term benefit to the joints. Do not be misled into buying a product that also contains

chondroitin, as this chemical does not add anything, but it can make the product more expensive. Look for a

product that contains the herb Boswellia serrata- this is a non-irritative anti-inflammatory. Although many

generics exist, the Pharmanex product, "Cartilage Formula" has the right ingredients and is of proven

efficacy. Expect improvement only over time (several weeks), but plan to use this indefinitely to maintain joint

health.

VITAMIN C

Vitamin C is important to aid in maintaining healthy connective tissues. High doses are recommended- 1000 to

6000 mg a day as tolerated (if the dose is too high for you it may cause acid stomach, gas and loose stools,

so therefore dose titration is necessary). Consider using “Ester-C” (non-acid and longer acting), or “C-Salts”

(very well tolerated). Start with a low dose and increase slowly to find your tolerance level.

FLEX CREAM

This is an amazing liniment-like product that really works and has a money back guarantee. Use for any type of

body pain- spread on a thick layer and do not rub in. It takes 30 to 60 minutes to work, then lasts many hours.

A Pharmanex exclusive.

OTHER OPTIONAL SUPPLEMENTS

VITAMIN D

Surprisingly, most people in America are vitamin D deficient. In the Lyme patient, low vitamin D levels can

cause diffuse body aches and cramps that are not responsive to magnesium or calcium supplements. Some

also believe that vitamin D is essential for normal immune and hormone function. I strongly urge you to have a

fasting blood level drawn. It is recommended that the blood levels be in the upper half or the normal range. If it is

not, then 2000 to 4000 units daily are needed for several weeks to make up for the deficit, and then a lower

maintenance dose may be necessary, based on results from repeated blood level monitoring. If vitamin D is

needed, improvements take 2 to 3 weeks to note, but are well worth the wait.

CREATINE

Creatine has been shown to be of benefit in neuromuscular degenerative diseases such as Lou Gherig’s

Disease (ALS) and can be very helpful in supporting low blood pressure, as in NMH. It may also benefit

strength, stamina, and heart function. Important: To use this safely, you must have an adequate fluid intake.

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The creatine product should contain taurine, an amino acid needed to enhance creatine absorption, plus some

carbohydrate to aid creatine entry into muscle. You will need a 20 gram daily loading dose for the first five

days, then 4 to 10 grams daily maintenance. Try "Cell Tech" from the Vitamin Shop, and follow label

directions.

MILK THISTLE

Useful to support liver function. Take 175 mg daily- use an 80% Silymarin extract. Available from many vitamin

stores.