I did finish the protocol. After almost four years, I had no reactions to the antibiotics, and the same was true for an extended metronidazole pulse. If I recall correctly, Rifabutin is optional, and a prolonged metronidazole pulse is recommended at the end of the protocol. Extra caution is needed when using Rifabutin; it's not like the other antibiotics in the protocol.
Emerging Stratton Protocol 4/2008:
"For those that have a major side effect on the pyruvate/macrolide alone, I'd continue to treat with the macrolide alone until the side effects are manageable. For those that don't, I'd add doxycycline 100 mg twice a day with 6 grams of pyruvate 1 hour before. Continue the NAC and Ibuprofen.
After two weeks of doxycycline if all went well, I'd add metronidazole 500mg twice a day with 6 grams of pyruvate before that. If a reaction is seen.
To the metronidazole, I'd then pulse it until the reactions were manageable.
If minimal reactions,
I'd continue therapy for at least 1 year and then recheck titers. If titers were low, I'd add rifampin or
rifabutin (preferably), using the rifamycin with pyruvate taken 1 hour before the rifamycin. If no reactions to this, I'd consider the therapy to be complete.
I would continue to monitor titers every several years. If the titers increased, I'd retreat with 6 months of clarithromycin or roxithromycin plus rifabutin plus pyruvate and ibuprofen. I'd continue the NAC for life."
i wouldnt call it optional. you can leave it out but this will decrease your chances of being cpn free. the guy had a lot of clinical practice so he developped the protocol further over the years. well im not saying cpn is the issue for you let alone comment on the coxsackie part bc i have no clue on that. just saying from my point of view you didnt finish the protocol because also if you do an extended metronidazol pulse without reactions that might mean there is still some cpn left (enough for the infection to rise up again later) and thats why he recommended to finish it off with rifabutin bc it is a stronger abx for cpn than metronidazol.
"For people on the existing CAP who are being switched:
For those on the current Doxycycline, Azithromycin, Metronidazole, and NAC protocol, my thoughts are that they should first switch from Azithromycin 250 MWF to Clarithromycin 500 mg twice a day (or Roxithromycin) and then add pyruvate
Dr. Stratton adds that Levaquin may be used instead of Clarithromycin for a short period (one month) as it has excellent activity for a short period of time. Clarithromycin = higher levels. Levoquin Both when combined with pyruvate theoretically will provide better killing."
do you have an opinion on the clarithromycin part? bc im on azithromycin and that part here never made sense for me bc i couldnt find where that statment comes from that clarithromycin gives "higher levels" which probably means higher abx concentration and hence better killing. i think i asked that before when cpnhelp was still online but i think nobody could explain it.