http://ilads.org/files/burrascano_0905.pdf

[cave note: I've bolded and spaced for ease of reading.]

COMBINATION THERAPY

Treatment of chronic Lyme usually requires combinations of antibiotics.

There are four reasons for this:

1. TWO COMPARTMENTS- Bb can be found in both the fluid and the tissue compartments, yet no

single antibiotic currently used to treat Bb infections will be effective in both compartments.

This is one reason for the need to use combination therapy in the more ill patient.

A logical combination might use, for example, azithromycin plus a penicillin.

2. INTRACELLULAR NICHE-

Another reason, discussed below, is the fact that Bb can penetrate and remain viable within cells and evade the effects of extracellular agents.

Typical combinations include an extracellular antibiotic, plus an intracellular agent such as an erythromycin derivative or metronidazole.

Note that some experts discourage the co-administration of bactericidal plus

bacteriostatic agents, thus the recommendation to avoid a cell wall drug combined with a

tetracycline.

3. L-FORMS (SPHEROPLAST)-

It has been recognized that B. burgdorferi can exist in at least two, and possibly three different morphologic forms: spirochete, spheroplast (or l-form), and the recently discovered cystic form (presently, there is controversy whether the cyst is different from the l-form).

L-forms and cystic forms do not contain cell walls, and thus beta lactam antibiotics will

not affect them.

Spheroplasts seem to be susceptible to tetracyclines and the advanced erythromycin derivatives.

Apparently, Bb can shift among the three forms during the course of the infection.

Because of this, it may be necessary to cycle different classes of antibiotics and/or

prescribe a combination of dissimilar agents.

4. CYSTIC FORM- When present in a hostile environment, such as growth medium lacking some

nutrients, spinal fluid, or serum with certain antibiotics added, Bb can change from the spiral form

(“spirochete”) into a cyst form.

This cyst seems to be able to remain dormant, but when placed into an environment more favorable to its growth, Bb can revert into the spirochete form. The

antibiotics commonly used for Lyme do not kill the cystic form of Bb.

However, there is laboratory [cave note: none, yet, in human vivo] evidence that metronidazole and tinidazole will disrupt it.

Therefore, the chronically infected

patient who has resistant disease may need to have metronidazole (or tinidazole)

[cave note;---- as I said, this is the 'gold standard'. Especially for newly infected or treated people.

However, I've read too much over the years to think that Burrascano's 'guidelines' are the ONLY way to use antibiotics for treatment! For every person who got better (many) following these guidelines to the letter, there's at least another who used different antibiotics/timing/length and achieved a remission--- short or long.]