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Dr Andersen: You are amazing. I am feeling very mild symptoms which scares me to think I am not at therapeutic levels. IMPT QUESTION # XXXXX How can I tell the doxy is working? This is a big issue for me.
Q2-Is Lyme a pathogen also more active at night? I wake 1am 4am and 7am- are rough times for me. Note I take doxy at 9am and 6pm.??? when I say rough - i mean wake to joint and muscle aches (not anything like thestate I was before anxious- i can go back to sleep! I understand herxing not necessary- how can they tell that bacteria is dying off?
Greetings! Here are the answers:
(1) Really the only way to tell is that the underlying infection is resolving or treated. This may take several weeks to manifest, though! The presence of a Herxheimer reaction is promising, but just as it is not necessary for it to be present for the treatment to work, its presence does not necessarily mean the treatment is actually working. Thus, symptoms resolution is a sure sign the treatment is effective.
(2) Since there is no really reliable way to tell if the bacteria is dying off other than symptoms, your improvement is an obvious sign the bacteria are being killed. They may have some new sophisticated ways to tell the Lyme bacteria are dying, but I'm poorly qualified to comment on that (the Infectious Diseases experts are the best bet there). While Lyme does not have, to my knowledge, the same day-night cycle that say, malaria has, it certainly is possible. Lots of our physiology changes at night, so it may also just be the norma wake-sleep cycle of the body which allows for more prominent symptoms.
Good Evening Dr Andersen:what is the therapeutic level that lyme bacteria get killed- is twice a day 100mg doxy it? or is it higher?
Thanks for looking into it for me.
Greeting! Yes, typically 100 mg twice a day is the accepted dose for infection treatment. Have you worked your way up to it yet?
Dear Dr Andersen: Margo here - re lymes / lorazapem.
Currently on 50mg doxy 2x a day. Seeing Infect Dis specialist next wed. Told on phone by PA that I came back neg on lyme and past infection with Bartonella. I still have joint pains, psychiatric symptoms. I know they will move dosage up to 100mg 2x doxy at that time. QUESTION 1-Can you tell me if this will outright kill neurological Bartonella or after that another antibiotic is required? Finally got proper diagnosis what is going on! Your insight needed and greatly appreciated. Tell me kindly what secondary antibiotic (if needed) you would choose as best for this situation. Thanks Margo
Can you tell me lastly QUESTION 1 about Rifampin in treating neuro bartonella. What I do know is doxy 100mg is first line for the lyme and bartonella. They said that since I had 3 bands lyme april plus past infection to bartonella- treatment is necessary because bartonella doesn't resolve itself without antibiotics. QUESTION 2 Is this correct?
This will end this string and will generously comp as usual. regards, Margo
Greetings! I actually found some very useful information on Rifampin use in Neuro Lyme:
Rifampin is a very old antibiotic that is very effective against Bartonella/BLO and the neurological and psychiatric manifestations of Bartonella/BLO (which can include severe anxiety and mood swings, panic, seizure-like episodes, memory loss, “spaciness,” confusion, and disorientation episodes, many of which you have experienced) You can expect a herx-like reaction during the first week or so with significant progress during the second or third week on rifampin.
Rifampin is best used in combination with certain other antibiotics. Frequently, those combinations include rifampin with doxycycline or rifampin with clarithromycin. The combination of rifampin with doxycycline is especially helpful with Bartonella/BLO and Lyme. The dosage of rifampin is 300 mg per day for the first week; increase to 600 mg once a day after the first week. Use of rifampin in the evening (not at bedtime) on an empty stomach, three hours or more after a meal or in the morning an hour before breakfast is recommended.
Regarding side effects, Rifampin is usually very well tolerated. It will turn your urine orange. It may cause headaches and sleepiness. Liver function and blood counts should be monitored at regular intervals. The greatest concern about rifampin is the potential for interactions with other medications. Rifampin speeds the metabolism of certain medications, resulting in an increased breakdown of the other medications. Clinically, this drug-interaction issue often becomes a problem when certain pain medications are being used, so it will be important to cross-check Rifapin against any other prescriptions you may currently have or might be prescribed.
Hope this helps! :)