Zithromax is very long-acting
Ordering Zithromax
Can I take generic azithromycin?
Dosing and administration
Combining Zithromax with other Marshall Protocol antibiotics
- Choosing a second antibiotic
- In combination with two other antibiotics
Patients experiences
References

Zithromax (azithromycin)

Zithromax can be very long-acting, taking weeks or even months to leave the system. Therefore, this antibiotic is unsafe for sicker patients. Zithromax should only be used by patients who have a serum 25-D measuring less than 12 ng/mL and are having trouble generating enough immunopathology with other antibiotics.

When used in combination with olmesartan (Benicar) or sometimes with a second antibiotic, Zithromax (azithromycin) can generate a powerful and prolonged immunopathological reaction in Marshall Protocol (MP) patients.

Among the MP antibiotics, Zithromax has an especially long half-life and can remain in the tissues for weeks or sometimes months. Patients have reported immunopathology (IP) up to 4-6 weeks after their last dose. For this reason, patients are expected to wait until their own immune function is returning before adding this antibiotic to their treatment plan. Indications of returning immune function include immunopathology that is not reduced by lowering antibiotics and a serum 25-D measuring less than 12 ng/mL.

Zithromax is dosed less frequently than the other antibiotics - every 8-10 days – and due to it's long half-life, patients must be careful when increasing this antibiotic. Symptoms typically peak three to six days after taking Zithromax.

In cases of acute infection or other urgent situations, MP patients should avoid taking additional amounts of the MP antibiotics (especially Zithromax) and instead opt for safer alternatives that don't increase the risk of intolerable immunopathology.

Zithromax is an azalide, a subclass of macrolide antibiotics. It binds to the 50S subunit of the bacterial ribosome.

Zithromax is very long-acting

The loss of MHC, CD40, and CD86 in dendritic cells also explains why Zithromax is so long-acting - it takes the body weeks to replace the lost cell differentiation. MHC loss, in particular, is a big deal.

Zithromax has proven a problem when members have to have unplanned hospital care, after an accident, for example. Many hospitals want to withdraw the olmesartan, a very dangerous decision if the patient still has Zith in their systems.

Trevor Marshall, PhD

Among MP patients, Zithromax has gained a reputation as a very long-acting antibiotic. In their exuberance to succeed on the MP, sicker patients have taken the antibiotic only to suffer through periods of intolerable symptoms of a month or more. Some have even had to go to the emergency room. At this point, however, there is not much that can be done beyond palliate symptoms using standard techniques for managing immunopathology.

A 2011 in vitro study, Zithromax suggests one mechanism by which the antibiotic can have a profound effect: inhibiting expression of co-stimulatory molecules (CD40 and CD86) and major histocompatibility complex (MHC) class II by dendritic cells.¹

Ordering Zithromax

Azithromycin tablets come in doses of 250mg or 500mg and often in a package of 6 or 3 – known as a “Z-pack” – but can be ordered in any number. 250 mg tablets will be easier to divide for the initial low doses.

Can I take generic azithromycin?

Azithromycin is the generic name for the antibiotic Zithromax. Generics are less expensive than a name brand. MP patients have reported no problems from using the generic form of azithromycin.

Dosing and administration

Combining Zithromax with other Marshall Protocol antibiotics

Choosing a second antibiotic

As specified in greater detail in the Protocol Guidelines, patients on the Marshall Protocol begin by taking regular doses of olmesartan (Benicar) and then, later on, increasing doses of minocycline. When ready to experience additional immunopathology, patients begin to take a second antibiotic.

That second antibiotic has historically been azithromycin (Zithromax) or clindamycin. Under certain circumstances, patients and their physicians may wish to use Sulfamethoxazole/Trimethoprim (Bactrim/Septra).

When to use clindamycin as a second antibiotic – Clindamycin doesn't linger in the tissues like Zithromax, so it is easier to control the immune system reactions. Clindamycin is helpful for patients who are very sick and may not be able to tolerate the relatively prolonged effect of Zithromax. Clindamycin can be quickly discontinued if necessary, and give a physician more options when treating acute trauma (after a car accident, for example) or other situations where surgery may be imminently required.
When to use Zithromax as a second antibiotic – Patients with difficult-to-control psychological symptoms such as depression, anxiety, intrusive thoughts, or obsessive-compulsive behavior should use azithromycin, because clindamycin often exacerbates these symptoms to intolerable levels. For these patients, clindamycin is usually tolerated better at later stages of the treatment. Some members have reported that these conditions resolve more quickly with clindamycin, however.

Patients who are still experiencing significant immunopathology from the Olmesartan / 100mg minocycline combination are not yet ready to add a second antibiotic because the two antibiotic combination, especially when Zithromax is used, is very much stronger than minocycline alone.

A special consideration for patients with high levels of 25-D – Patients should not begin azithromycin until their serum level of 25-D drops below 12ng/ml, at which point, they may carefully introduce it. The reason for this caution is because a high level of 25-D suggests a relatively inactive immune response. By taking shorter-acting antibiotics such as clindamycin (as opposed to azithromycin), patients may minimize the length of time they experience a profound response to their antibiotics. An exception may be made for patients who are healthy enough to handle a substantial increase in immunopathology. In this case, physicians may want to wait until a patient's 25-D drops below 20ng/ml.

In combination with two other antibiotics

In later stages of recovery (Stage 4 and beyond), antibiotics have been safely combined combined in the following fashion:

BDZ – Bactrim DS + demeclocycline + Zithromax
BMZ – Bactrim DS + minocycline + Zithromax
CDZ – clindamycin + demeclocycline + Zithromax
CMZ – clindamycin + minocycline + Zithromax
DMZ – demeclocycline + minocycline + Zithromax

Patients experiences

I agree with being very careful with the Zith. Only 3mg difference in the amount of Zith tablet (actually only about 1.8 mg of actual Zith) makes a significant difference in my neurological IP levels (anxiety, ADD, cramps). My current threshold is 43 mg of Zith tablet (about 26 mg of actual Zith). At 40 mg, I don't notice much IP, but just raising it to 43 mg of Zith tablet brings significant IP for me. I think the best way to measure the Zith is with a digital scale. I bought a ProScale Gemological scale that measures down to the milligram when I realized how sensitive I was to the Zith. I keep a razor blade in the Zith bottle that I use to cut pieces off of the tablet. I place a small piece of paper on the scale, then turn it on (it will tare to zero with the paper on it). Then, using the tweezers that came with the scale, I put pieces of Zith tablet on the scale (on top of the piece of paper) and take them back off, cutting them into smaller and smaller pieces, until I have the amount I need in milligrams. Then I take the piece of paper with the Zith pieces on it off of the scale and drop them into some water to drink.

FindingAnswers, MarshallProtocol.com

Keywords: antibiotics

Notes and comments

EDIT

Remember to cover the topic of “weaning” from Zith too.
Umm, I wouldn't know how to wean Z. Just stop it??? –Paul

Weaning zith: decrement the dosing level by 1/2 each 10 day cycle and discontinue after one cycle of 16mg (typical).

References

^1. Iwamoto S, Kumamoto T, Azuma E, Hirayama M, Ito M, Amano K, Ido M, Komada Y The effect of azithromycin on the maturation and function of murine bone marrow-derived dendritic cells. Clin Exp Immunol. 2011;166:385-92.

Last modified: 01.02.2012