The following Mycoplasma treatment guidelines were taken from the Shasta CFIDS Support Group Website.... As with any treatment suggestions given by Shasta CFIDS Support Group the information is intended to help you make informed decisions about your health. It is not intended to take the place of medical advice. These suggestions for treatment should be shared with your physician to help with your plan of care. ANTIBIOTICS The antibiotics recommended by researchers and specialists to treat Mycoplasma are the following: Doxycycline, Ciprofloxacin, Azithromycin, Minocycline, Clarithromycin, and Levaquin. Antibiotics recommended by Dr. Garth Nicolson (for complete recommendations, go to his web site : www.iimmed.org) are all at a fairly high dosage. He recommends starting with Doxycycline. But, if you are chemically sensitive, Ciprofloxacin may be the first antibiotic of choice. For those infected with the species of Mycoplasma hominus, Azithromycin may be the most effective. Oral administration works well for most patients, but a few highly sensitive individuals may need to have an initial two week course of antibiotics given intravenously. Minocycline is what most people have used for an I.V. antibiotic. If you start with I.V. administration, you may want to have a heparin loc. catheter placed into a vein for ease of administration. You will need the usual dose twice a day for at least the first two weeks. Also, there are home I.V. services that will administer the antibiotic if you are not able to do it yourself. Garth Nicolson’s first study group took the antibiotic in 6-week cycles. They then stopped for a while to determine if the antibiotic was a cure. But, results of that first study demonstrated that 100% relapsed after the first cycle, 88% after the second cycle, 64% after the third cycle, 47% after the fourth cycle, and 25% after the fifth cycle, and 11% after the sixth cycle. All in all, that is six cycles of 6 weeks each for a total of 36 weeks or nine months treatment. Therefore, based on the decreasing percentages of relapses in this first study, it has been suggested that a cycle should be longer than 6 weeks. Many have even taken the antibiotic continuously for a year or more, with excellent results. Doxycycline seems to cross the blood-brain barrier better than other antibiotics on the list, so if your predominate symptoms are neurological, you may want to start with this one. It is also the Nicolson’s first drug of choice. The enteric-coated tablet seems to be less troublesome than the capsules. Less gastro-intestinal (as well as, Herxheimer) symptoms are reported with the enteric-coated tablets. The antibiotics should be taken on an empty stomach, but a dry cracker taken before taking the Doxycycline can also be helpful for the slight nausea experienced. Also, the generic form of the antibiotic may not be as effective, so always ask for the brand name. The first two or three weeks of the treatment will be the most difficult in terms of symptoms. You will definitely feel worse before you feel better! Although you may want to stop the treatment, try to hang in there. If you feel worse at first, it is really a good sign!! It means that the organisms are dying. As the antibiotic kills the organisms, they produce a toxin, which stimulates our (already over-active) immune system. This reaction is called Herxheimer, and is discussed below. Do not take antibiotics at the same time as minerals (such as those found in vitamins and antacids). Also, do not drink alcohol at any time while taking antibiotics. Oral antibiotics must be taken with a full glass of water to avoid esophageal irritation. Also, remain in an upright position for at least one half hour after taking the antibiotic to prevent it lodging in your esophagus and causing a burning. It has been found that minerals may decrease the absorption and effectiveness of the antibiotic, so avoid taking them, or milk products, at the same time. Antibiotic uptake may be inhibited by various drugs and many drugs may also inhibit immune responses. To achieve the maximum response to treatment, please try to limit or eliminate the following drugs: alcohol, anti-depressants (sertaline or Zoloft, fluoxetine or Prozac, amitriptyline or Elavil, maprotiline or Ludiomil, desipramine or Norpramin, clomipramine or Anafranil, nortriptyline or Pamelor, bupropion or Wellbutrin), muscle relaxants (cyclobenzaprine or Flexeril), opiate agonists, anticonvulsives or analgesics (oxycodone or Percodan, carbamazepine or Tegretol, acetaminophen/hydrocodone or Vicodin), narcotics (codeine w/ Phenergan, propoxyphene or Darvon, morphine), antacids, antidiarrheas, metal salts, others. Because of the recent data concerning combination therapy, the following medications/supplements may be helpful in augmenting the antibiotic therapy. Colloidal Silver taken orally (a natural antibiotic, antifungal, antiviral) Monolaurin, or Lauricidin (a natural antibiotic, antifungal, antiviral). An antiviral (Zovirax, acyclovir, &/or Labucavir.) Some add the antivirals Acyclovir, Famvir or Labucavir for the first 2 weeks in a 6-week antibiotic cycle. Since Mycoplasmas have some characteristics of viruses, antivirals can have a useful effect, and viral infections are also important in CFIDS. While we are blazing new trails with this treatment, we need to do whatever works for each of us, individually, because there is no set course or "tried and true" recommendations for treatment, yet. When most of your symptoms are gone, we are not certain if one is "cured" or the organism is reduced in enough numbers for the immune system to keep it under control. Therefore, a periodic cycle or a maintenance low dose of antibiotics may be necessary for months or years. Try to avoid those things that can cause a relapse. The most common things are: strenuous exercise, chemical exposure, extreme stress, etc. Otherwise, those things that weaken the immune system and consequently allow the Mycoplasma to reactivate. During this time, it is important to support your immune system. A healthy immune system may be all that is needed to get and/or keep the organisms dormant. HERXHEIMER REACTION A Herxheimer reaction occurs from the organism die-off. The dead organism triggers the immune system to respond to toxins given off in the dying process. Since our immune system is already overactive, the cytokine production will be stimulated. The already elevated cytokines (such as interferon, interleukin, tumor necrosis factor, etc.), are the cause of most of our symptoms, anyway. So, when they are stimulated even higher by the die-off, all of our usual symptoms will worsen. Symptoms that are associated with a Herxheimer are the following: chills, fever, night sweats, muscle aches, joint pains, mental fog, and extreme fatigue. (Sound familiar?) You may want to plan on doing nothing for the first week or two of treatment. Also, keep plenty of pain medications on hand, arrange for a massage therapist, have a Jacuzzi handy, and alert the family that you will need plenty of rest, space, and tender loving care during this time. If the Herxheimer is too severe, many people have eased the symptoms with Whole Lemon-Olive Oil Drink (see recipe below.) Taken every day, this drink helps the lymph glands to filter and move the dying organisms. Drink at least two quarts of fresh, filtered water every day to flush the organisms from the body. Whole Lemon-Olive Oil Drink 1 whole lemon---washed and blended until smooth 1 cup of juice or water added to the blended lemon 1 tablespoon of extra virgin olive oil---blended with the lemon (Montolivo is the best brand) Pour through a wire strainer Discard pulp and drink liquid New research is under way that may help to eliminate the toxins that are produced by the dying organisms. Some have tried a combination of Actos and the anti-cholesterol drug Questran (Cholestyramine) to rid the body of the low molecular weight fat soluable ionophore neurotoxins produced by the dying Mycoplasma with some success. This treatment was perfected by Richie Shoemaker, MD to treat those with Lyme Disease. RESIDENT BACTERIA LOSS Because the recommended antibiotics are very powerful, and broad spectrum, they tend to kill the good resident bacteria in our bowel and else where, as well as the harmful organisms.When the "good" bacteria is wiped out, then another form of organism can flourish. The most common organism to flourish when we are treated with long-term antibiotics is yeast (with Candida being the most frequent). Yeast’s normally reside in the gastro-intestinal system, from the mouth to the anus, and in the vagina. But, its overgrowth is kept under control by the resident "good" bacteria that also reside with it. Nearly everyone on long-term antibiotic therapy will have a yeast infection at some point in time! In addition, those with CFIDS seem to have an immune dysregulation that hampers control of the growth of yeasts. There are two forms of yeast, the spore-form and the mycelial-form. The spore-form only infects the lining of the mucous membranes, but the mycelial-form will go deeper into the tissues, and become systemic. If one only limits simple sugars and starches in the diet in an attempt to control the spore-form of Candida, it will become a protein-loving organism, and change into the mycelial-form, going deeper into the tissues in search of protein. Therefore, one should treat yeasts with medications and diet (limit simple sugars and starches). An overgrowth of yeast in the mouth and throat will often cause the tongue to become coated with a white or yellowish growth and the throat may become sore. An overgrowth of yeast in the intestinal tract will ferment the sugars and starches in our food, forming acids, gas, and alcohol. Symptoms include gas, heartburn and/or pain in the stomach area, and because of the alcohol formation, there can be headaches, dizziness, lightheadedness, and wooziness. Yeasts also produce enzymes that digest proteins and fats in order to attach themselves to the gut mucosa lining. This may cause "leaky gut syndrome". The "leaky gut" allows a larger molecule of food to pass through the gut membrane. Food sensitivities and allergies can form when the immune system recognizes these larger molecules of food as foreign and sets up a defense against them. A vaginal yeast overgrowth may manifest itself in a white or yellowish, itchy discharge and/or symptoms of a bladder infection (urinary frequency, urgency and burning upon urination). If you think you suffer from a yeast infection, a serum antibody test for yeast or a serum arabitol test can be done. (Aribitol is found to be elevated in those with proven invasive Cadidiasis.) Various medications for yeast infection of the mucous membrane can be helpful, such as Nystatin, Mycelex, and Mycostatin as well as various herbal preparations. These medications may come in the form of tablets, lozenges, liquids (swish and swallow) and/or vaginal preparations. Flagyl, Diflucan, and Amphotericin are reserved for the mycelial-form and circulate throughout the body. In addition to the above medications, Natamycin and Miconazole are now available in the United States, but only from a pharmacist who can "compound" the medication (and, of course, upon a physician’s prescription). In addition, a supplement called Micropreyl (a combination of garlic, magnesium, calcium and caprylic acid) may also be helpful. You may find that a continuous dose of an antifungal is necessary while you are taking antibiotics. As with antibiotic therapy, expect a Herxheimer "die-off" reaction to occur following the beginning of any antifungal therapy. The "good" bacteria are necessary in the bowel to help with absorption of nutrients from our food. Symptoms of lack of good bacteria in the bowel include constipation and easy bruising. Every day, while on antibiotics, replenish the bowel with a product that contains "good" bacteria. Do not take it at the same time as you take your antibiotic, however. Many good products can be found at the health food store. These contain transient bacteria; i.e., Lactobacillus acidophilus, Bifidobacterium, etc. and/or human strains of acidophilus such as Kyodophilus by Kyolic and Maxidophilus by Ethical Nutrients. Long-term use of antibiotics can permit the overgrowth of another, resistant bacteria called Clostridium difficile (an anaerobic spore-forming bacteria). The main symptom of this unwanted bacterial overgrowth is diarrhea (often watery and explosive). Treatment with another antibacterial agent that is clinically effective against this organism may be necessary before one can resume the antibiotics for Mycoplasma. However, regular use of the lactobacillus/acidophilus preparations seems to be helpful in controlling this antibiotic related colitis. IMMUNE SYSTEM SUPPORT When the body has had a long-term infection with an organism like Mycoplasma, it takes a tremendous toll on the immune system. The immune system is weakened by this organism because it infects the very cell that should kill it-- the leukocytes (or white blood cells)! Cell destruction and oxidization occurs. Once the immune system is rid of the organism, it can become healthy and fight the Mycoplasma more effectively. Once the immune system starts working in a more healthy manner, the Mycoplasma may be killed completely or go dormant. It has been suggested by a number of specialists treating Mycoplasma, that the following nutrients may be helpful: B complex vitamins (the sublingual form is best because it crosses the blood-brain barrier and goes to the affected nerves. Magnesium Selenium: Interferes with the replication of Mycoplasma when taken at300-500 mg/day Salmon Oil (May prevent Mycoplasma from attaching to cell wall) Antioxidant supplements CO-Q 10 Vitamin C Alpha Lipoic Acid Pycnogenol Beta Carotene Vitamin E Glutathione Super Oxide Dismutase Bioflaonoids OXIDATIVE THERAPY Oxidative therapy appears to be useful in suppressing infections. Hyperbaric oxygen, American Biologics Dioxychlor are useful, or peroxide baths using 2 cups of Epsom salt in 20 inches of hot bath or Jacuzzi. After 5 min add 2-4 bottles 16 oz. of 30% hydrogen peroxide. Repeat 2-3X week; no vitamins 8 hr before bath. The hydrogen peroxide is added after your pores open. Hydrogen peroxide can also be directly applied to skin after a work-out or hot shower/tub. One approach is to apply Swedish Beauty type A tanning accelerator for 5 min before peroxide. Leave hydrogen peroxide on for 5 min and then wash off. For oral irrigation, mix 1 part 30% hydrogen peroxide with 2 parts water and use like a mouth wash 3X per day. Most chronic illness patients have dental problems, and infections are common.