Uit de behandelprotocollen op Lymemed ter behandeling van persisterende of terugkerende symptomen na eerdere behandeling:
http://www.lymemed.nl/protocollen/schema.pdf
Info uit het farmacotherapeutisch kompas over deze middelen:
https://www.farmacotherapeutischkompas. ... itromycine
https://www.farmacotherapeutischkompas. ... trimoxazol
Naar aanleiding van een studie van R. Gasser et al, waarin te lezen is dat cotrimoxazol het effect van roxitromycine in vitro versterkt en in vivo bij 13 van de 17 patiënten tot volledig herstel leidde ook nog bij de follow-up na 6 en na 12 maanden:
https://www.ncbi.nlm.nih.gov/pubmed/7782115
In vitro (checkerboard technique; B. burgdorferi strain B31; modified BSK II medium) it was found that while roxithromycin showed excellent efficacy against B. burgdorferi (MIC 0.031 mg/l), co-trimoxazole had no effect. However, the combination of both chemotherapeutics led to a minor synergistic effect, decreasing the MIC for roxithromycin by one dilution step at concentrations of co-trimoxazole from 256 to 8 mg/l. In addition, a clearly reduced growth of microorganisms was seen at concentrations of roxithromycin as low as 0.015 mg/l in combination with 256 to 4 mg/l co-trimoxazole, when compared to the positive controls. Most interestingly, however, the motility of B. burgdorferi was markedly reduced even when the two drugs were combined at very low concentrations.
In an in vivo, non-randomised, open, prospective pilot study it was found that of 17 patients with confirmed late Lyme borreliosis (stage II/III), treated with combined roxithromycin (300 mg b.i.d.) and co-trimoxazole for 5 weeks, 13 (76%) recovered completely by the end of treatment, and four continued to have symptoms on follow-up at 6 and 12 months. This success rate is similar to that seen with i.v. penicillin and ceftriaxone. It appears that the reduced motility of B. burgdorferi makes the pathogen more accessible to the immune system.
Josie
