Jemsek Protocol

(Dr. Neilson also uses this protocol) 

Patients are treated with antibiotics Monday, Wednesday, Friday, alternate weeks. That means they’re taking antibiotics the last phase of  therapy, 6 days a month. The bug isn’t figuring out a pattern and developing resistance. He’s giving 3 antibiotics in pediatric doses and then building up to adult doses and then dropping number 4 and giving number 5 as he works his way up to 8 to 10 antibiotics that get tougher and tougher. When you get into the really big antibiotics that’s when you start seeing all of the symptoms go away. With most patients he says as long as you’re making progress he doesn’t care how long it takes. He usually expects to take about a month working out nattokinase, 6-8 months on LB Core, and about a year of antibiotics. So about 2 years to get most people to a maintenance program. When they’ve finished their LB core he asks his patients to compare what their symptoms were when they came in and call that 10, perfectly well a 0…what are you today? Most will answer a 3 to a 4. At this point they’re starting to engage the world again. As they move into triple antibiotic cycle they’ll get more herx reaction, lose a little ground but will watch brain fog to get worse but the rest of their symptoms to go away. In a year they’ll come back and say they’ve accomplished a 1 or 1 ½ . expect people to relapse eventually. Jemsek would take people on antibiotics from every 4 to 8 then leave on every Monday, Wed, Fri on a 12 week cycle. Nielson may put them on an LB core program treating every month out of four and tells his patients, don’t ever stop taking nattokinase.

Dr. Jemsek, considers urinary frequency along with stiffness of the neck along with brain fog to be the classic triad. Most lyme patients have urinary frequency. Dr Neilson saw a patient with bladder ulcers from lyme disease.

From the Jemsek site:

Obviously, our ultimate goal is Bb eradication, if possible, or at least a state of competent immune surveillance resulting in lasting relief from disease. As successful treatment progresses, return of symptoms off therapy becomes more delayed and symptoms tend to be milder. During the first week or two on holiday, our patients invariably remark that they feel the best they have since becoming ill. Obviously, when a patient ceases to relapse on holiday, it is taken as a positive indication. It is even more encouraging at that point if the patient fails to exhibit any sign of Herxheimer reaction (see below) during the ensuing treatment cycle, suggesting that Bb die-off is clinically non-detectable. In general, we have informed patients that therapy may extend for two or three years before they may reach an asymptomatic state. At this point in therapy, we would consider performing a “test of suppression”, probably by utilizing newly available urinary antigen detection testing procedures such as the urinary Dot-Blot test through Igenex laboratory (128), in a protocol that employs an antibiotic challenge to enhance Bb shedding in the genitourinary tract. Pre and post therapeutic trials with more sensitive laboratory markers are needed.

The use of IV clindamycin has now become routine in our treatment protocol for advanced neuroborreliosis. This change came about after we began using oral clindamycin (with mepron) empirically for suspected cases of babesiosis coinfection in our most recalcitrant, unresponsive patients. We immediately noted some new and positive developments, e.g. absence of fever and night sweats for the first time in months/years, increased mental acuity, and so forth. Other patients had Herxheimer reactions that they had not experienced for weeks on prior therapy, even though we were treating aggressively with both intravenous and oral antibiotics. Since our most debilitated patients were already on IV therapy, we decided to try short courses of IV clindamycin and the effect has been consistently impressive, even more so than with the oral formulation. We have now gone back and retreated those patients who have had an incomplete response to prolonged IV therapy, and in 11/12 of these cases, improvement on IV Clindamycin has been dramatic. We are currently in the process of evaluating the optimal use of clindamycin, as we continually do with all of the therapies we employ. Our hope is that these more intensive therapeutic programs still provided in such a way that they are tolerated, will allow us to shorten the IV program by hastening the time to clinical improvement.

In order to address the pleomorphic nature of Bb in cyst formation, we routinely cycle metronidazole during the treatment period, thereby achieving three separate active modes of treatment (extracellular, intracellular, and cystic). Since it is very difficult to maintain a patient on such intensive therapy for a prolonged period, the rotation of oral antimicrobials through the IV treatment period has been quite helpful in term of program tolerance. In fact, out of tolerance concerns, metronidazole is typically given intermittently and on a short term basis because of its propensity to cause severe Herxheimer reactions, especially in patients with advanced illness. Because of the complex drug issues in patients who invariably risk great morbidity, we accommodate each individual with a treatment plan that is best suited for them. While we have developed a protocol for general guidance, we understand that it is the exception to the rule that creates new insights about the treatment of Bb. This is how our protocol evolved and continues to evolve; by careful observation and documentation of the clinical presentation using well established scientific data in order to craft sophisticated empiric therapy. Prior to any treatment, IV or oral (or both), our patients are educated in the use of probiotics and schooled to observe for potential side effects. Safety labs are performed weekly or biweekly. Specific considerations in IV therapy include the addition of Actigall (ursediol), which seems to reduce the incidence of ceftriaxone-induced cholelithiasis (personal reference) and is well tolerated. When using imipenem, we add probenecid in order to boost drug levels during twice daily dosing.

In administering these treatment programs, the Jemsek Specialty Clinic is cognizant of criticism concerning outside perceptions and opinions of excessive or unguided antibiotic use by our clinic. Certainly, we do not now and never will condone indiscriminate use of these important and valuable drugs. In view of our training and experience, we are completely confident in our use of these medications. In response to any real or potential criticism, we would reply by pointing out that we are treating seriously ill and/or impaired individuals who have not responded to conventional medical therapies. As mentioned previously, we are encouraged that a significant percentage of our patients are responding to our care, including several individuals who had been totally incapacitated for appreciable periods of time. We acknowledge that the understanding of neuroborreliosis is incomplete and so we continue to study the entire process of diagnosis and treatment for Bb infections. We look forward to the day when funding and scientific support for Bb research is available.