Dosage and administration of Marshall Protocol antibiotics

The Marshall Protocol (MP) is distinguished from other antibacterial treatments in at least two key respects. For one, MP patients take regular doses of the Vitamin D Receptor agonist, olmesartan (Benicar). Also significant is the use of pulsed low doses of specific antibiotics; pulsed dose allow plasma concentrations of a medication to wane between doses. Used in conjunction, these two interventions generate an immunopathological reaction. Patient feedback suggests that in the absence of regular doses of olmesartan, patients can only generate a fraction of the immunopathology they do on the MP.

The Phase One and the Phase Two/Three guidelines specify a series of steps for moving from one dose and combination of antibiotics to the next. Understanding the rationale behind these instructions and knowing when to vary them can help keep a patient safe and experiencing tolerable immunopathology. As always, MP patients are encouraged to work closely with their physician.

Antibiotics may be taken with or without olmesartan, and with or without food. However, some patients have found that taking antibiotics without food leads to gastric upset.

Taking minocycline with dairy products or calcium may alter its absorption. Patients should take this into consideration only if they need to eliminate any variable that might be affecting immunopathology. In that case, take the minocycline dose one hour before or two hours after consuming dairy products or other foods high in calcium. Otherwise, it is okay to take minocycline with food.

In the hours after taking minocycline, when concentrations of the antibiotic are relatively high, the body is immunosuppressed. This leads to feelings of temporary symptom relief and well-being.

As per the Phase One and Two/Three instructions, MP patients begin taking an antibiotic at the minimum dose, which varies for each antibiotic, and increase it gradually, sometimes over the course of months.

All of the different MP antibiotics have a time-concentration curve similar to minocycline (see figure). When an antibiotic is first ingested, levels of the antibiotic spike. This results in temporary immunosuppression. The window of feeling symptomatic relief following consumption of an antibiotic is about hours two to four for minocycline, clindamycin, Bactrim DS, and demeclocycline. On the other hand, azithromycin (Zithromax) typically results in feelings of temporary well-being on days two to four following administration.

Unlike treatments which employ high doses of antibiotics, the MP has patients take antibiotics only every two days. This limits the time during which a patient's immune system is suppressed and extends the time during which it kills bacteria. To prevent extended immunosuppression, patients should take note of the upper limits on the amount of antibiotic to be taken at one time.

The constantly variable plasma concentration of an antibiotic means that the MP can be forgiving of small errors of dose or interval. Provided a patient is experiencing tolerable immunopathology, the exact amount of antibiotic is taken is somewhat immaterial. It may help to think that it's not the antibiotic killing the bacteria but the immune system.

While it's probably a good idea to take one's antibiotics at the same time of day on days they are to be taken, there is no preferred time. The question of when to take one's antibiotics has as much to do with when a patient wishes to benefit from the temporary immunosuppression. Some patients prefer to take their antibiotics before bedtime to sleep through some of the immunopathology. Others figure taking them in the morning will mean they sleep through the worst immune system reaction on the second night. Still others take an increased dose just before their days off from work because they can tolerate more immunopathology when they are not working.

The choice to increase or vary antibiotics taken is one that should be made in conjunction with a patient's physician and according to the Phase One and Phase Two/Three guidelines. The time spent on each phase varies between patients but some data has been collected.

Unlike, olmesartan, which should not be ramped, antibiotics should be increased incrementally and over time, to ensure both safety and efficacy of the treatment. To do so, patients may need to divide their medications.

One of the strategies for managing immunopathology is to increase the frequency with which one takes minocycline. When necessary, taking frequent doses of minocycline is a perfectly acceptable way to mitigate a robust immune response.

In the past, MP patients were encouraged to quickly ramp their antibiotics combinations to full doses of MZC, but this has been de-emphasized as the science of recovery on the MP has evolved.

Based on new research revealing the key activities of the VDR when activated by the VDR agonist olmesartan (along with anti-microbial activity of olmesartan), it is now believed that it is not necessary to use maximal doses of MZC to recover the function of the innate immune system's ability in order to clear pathogenic load or induce recovery.

The older guidelines used to be like a “cookbook” approach, but it seemed that it drew attention to the wrong things–like dosage levels and types of antibiotics.

Success on the MP requires a different focus. One that first and always asks the question: “What is the immune response doing now?”

If you find yourself getting stuck and all you had was a “cookbook,” you would be tempted to just keep trying the same old “recipe” you keep reading over and over.

The people that do the best on the Marshall Protocol are posting their medications/symptoms/experiences here on the forums so there can be a conversation about what has helped others and what you might try next.

We have one member that felt too stuck with benicar alone, but could not tolerate minocycline. Since that time she has had some success with low doses of clindamycin. Not a typical or even recommended approach, but one that seemed to provide a more tolerable experience for her.

Also, some have taken Bactrim as their second antibiotic before trying clindamycin or azithromycin with good results. And then we have those who have not taken antibiotics and yet are experiencing strong immunopathology and symptom resolution.

It is important to treat each individual with respect for their unique immune response instead of trying to force fit everyone into the same pattern.

Joyful, MarshallProtocol.com