ok - will take another look in case i missed anything
the main thing i got from the full paper was what looks to me like a very high dosage used of cefotaxime via IV
- 3x 4g per day on the pulse days
the other thing i picked up was in this paper it talks about
replication times for bb of around 33hrs
but i had seen previous papers or articles by LLMD's taking about
30 days - so i wonder if one of them is a typo or misunderstanding
this has relevance to the pulsing discussion as if a surviving population of bb persister starts to regenerate by
doubling each 30hrs - then in around 1 week from stopping an abx pulse it will be something like 128x larger in number - so even if the abx killed 99% - the population would be back to full strength (assuming simple mathematical progression )
by comparison -
if it doubles only every 30 days - then after 7 days it will be more or less at the same population that was left after the abx pulse
based on the 1-4 week pulse cycles typically in use clinically for bb - i guess the 30hrs number is the correct one
and we might therefore have reason to steer more towards the shorter pulse cycles of 1 week
although in practice i think there is some kind of lag time in the bacteria's response to removing the ABX - in that it takes a while for it to recognise its surroundings have changed and start growing again - a few days i think -
it also takes a day to a few days for the abx to come out of our system (depending on the half life of the particular drug) - so that could be expected to delay the bacteria's response also - and thereby increase the ideal timing of the next pulse.
the target seems to be when the maximum number of bacteria are fully into their logarithmic growth mode - but before they start to slow down growth and enter persister states ( exactly when this happens in human hosts and why is barely touched upon in studies we have covered so far ) and certainly before their numbers reach the same as pre-treatment levels - and drive symptoms to similar levels.
based on this somewhere between 1 and two weeks is starting to look to be the ideal range of pulse cycle length for bb.
Post Edited (Garzie) : 6/16/2021 6:15:06 AM (GMT-6)