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Prescription Antifungals -- "Triple Therapy"

Yeast and fungi develop resistance to anti-fungal medicines, and a significant percentage of yeast and fungi in the body at any given time will be resistant to any one specific medicine. In clinical practice, it has been much more effective to combine several anti-fungal medicines simultaneously. Two and preferably three of the following medicines are given together for two months or longer. The following medicines require a physician's prescription:

+ Nystatin: Brand names include Nilstat, and Mycostatin (available in powder, tablet, suspension, suppository and capsule forms). Generic forms of nystatin are also available but they tend to be bitter and impure. Only the pure powder is free of chemical colorings, additives, and allergens.

The powder, taken directly into the mouth, is more effective, and eliminates yeast in the mouth which can seed the intestine. The usual dose of nystatin powder is 1/4 teaspoon four times daily (which is equivalent to 4 tablets containing 500,000 units each four times per day). This is twice the dose customarily prescribed by most physicians. Nystatin is not absorbed from the digestive tract in any significant amount and is an extremely safe medication, even at higher doses. This recommended dosage is what works best in practice.

Nothing should be taken by mouth for 20 to 30 minutes after taking the nystatin powder. This allows a coating to remain in the mouth and upper digestive tract long enough to eliminate yeast in those locations. Prolonged administration is usually necessary--several months (occasionally a year or more) before full benefit is achieved.

The "rare-food diet" is maintained throughout the period of anti-fungal therapy and for several weeks thereafter. Gradual improvement is usually observed during the second and third month of therapy--although sometimes sooner. This program requires patience. After improvement plateaus out, and symptoms are much improved, medicines are discontinued.

If symptoms return, anti-fungal medicines may again be prescribed and offending foods eliminated until improvement persists without medication. Rapid and persistent improvement has been experienced much more frequently when two or three anti-fungal medicines are given together. When improvement is maintained for at least a month without medication, a more normal diet may gradually be resumed, testing each added food for sensitivity as described above.

Eliminated foods are added back one at a time to test for continued sensitivity. Directions are contained in the book, DETECING YOUR HIDDEN ALLERGIES, by Dr. Crook.

If antibiotic therapy should become necessary for treatment of well-documented and serious bacterial infection, which would not otherwise resolve, it is advisable to subsequently resume the anti-yeast program for a month or more, but only after antibiotics are discontinued. Administration of anti-fungal medication simultaneously with antibiotics could theoretically promote the growth of resistant fungal organisms against which no therapy would be effective.

Broad-spectrum antibiotics such as ampicillin, tetracyclines, and the cephalosporins are more likely to cause yeast overgrowth. Treatment with topical antibiotics on the skin or the use of less potent antibiotics, such as penicillin-VK, sulfisoxazole, and nitrofurantoin, are not as likely to reactivate yeast overgrowth.

Nystatin powder should be stored in a refrigerator if kept for a prolonged period, although a few weeks at room temperature will not cause a problem. Nystatin slowly takes on a bitter taste at temperatures higher than 80 degrees Fahrenheit. Nystatin should not be exposed to high temperatures or left in a parked automobile on a hot, sunny day. Taste and bitterness normally vary somewhat from batch to batch. Nystatin is one of the least toxic of prescription drugs. It is safer to use than most non-prescription products. Nystatin merely coats the interior of the mouth, throat, esophagus, stomach and intestine, preventing yeast from multiplying.

Mild side effects may occasionally occur during anti-yeast therapy, including nausea and skin rashes. Most such symptoms are the result of yeast die-off and not from the nystatin itself. Some patients may experience a temporary increase in the symptoms of CFIDS, such as fatigue and depression during the first few weeks of treatment with anti-fungal medicines. This phenomenon has been attributed to a yeast "die-off" effect or Herxheimer's-like reaction and long-term benefits are not reduced. If the medicine is stopped too soon, yeast can easily recolonize.

Nystatin powder is preferred over tablets, capsules and suspensions because the pure powder contains no chemically derived coloring agents, binders, flowing agents, sugar or other potential allergens. The powder begins its work in the mouth and coats the upper digestive tract. Tablets and capsules do not dissolve until they reach the stomach or lower and are therefore less effective. Commercially available suspensions marketed for the treatment of thrush contain very little medication, which is suspended in a solution of sugar. The pure powder is much more effective.

Nystatin powder is best placed on the tongue dry by inverting a half-teaspoon measuring spoon in the mouth and tapping the spoon against the upper teeth, then allowing the powder to mix with saliva. Then rub it into the tongue and swish it around for several minutes in contact with the tissues in the mouth and throat, before swallowing. Doses as high as 1 or more teaspoons, 4 times daily, have been used safely.

Nystatin powder possesses two advantages over tablets and capsules. It is less expensive and, it is effective against yeast in the mouth, throat and esophagus where the tablets and capsules have no effect. Patients with symptoms of sore tongue, canker sores, indigestion and heart burn (hiatal hernia or esophagitis) improve more quickly following treatment with nystatin powder--providing evidence that yeast overgrowth is at least partly responsible for those symptoms.

If saliva is not adequate, a small sip of water or juice may be used to swish the powder into the mouth, making a paste to coat the gums and tissues. Small children may object to the taste unless a small amount of fruit juice or applesauce is used to mask the taste of medicine. The more concentrated the nystatin, the more effective it will be.

Female patients may improve more rapidly with the simultaneous use of small doses of an anti-yeast vaginal cream, one-half applicator or less once daily at bedtime, when symptoms of vaginitis are present. Some yeast are normally present on vaginal tissues and even small numbers may increase symptoms in a highly sensitized patient. Keeping yeast colonization to a minimum throughout the entire body for several months lowers stress on the immune system and allows gradual recovery.

Vaginal creams and suppositories all contain a chemical preservative, which is potentially allergenic. It is possible for the creams themselves to cause allergic symptoms which mimic yeast. If Sporanox or Diflucan is used together with nystatin, as described below, vaginal therapy is usually not necessary.

+ Diflucan (generic name fluconazole)is very similar to Sporanox. Diflucan seems to work somewhat better when vaginal yeast is a symptom. Concentrations of Diflucan in body fluids are somewhat higher than Sporanox but Diflucan is not concentrated as much in skin and nails. Otherwise, in practice there does not seem to be much difference between Diflucan and Sporanox. It probably does not make much difference which one of the two medicines is used.

Either Sporanox or Diflucan is used as one of the three anti-fungal medicines administered in combination. But Sporanox and Diflucan are never prescribed together.

+ Amphotericin-B is an anti-fungal drug which, like nystatin, is very safe and not absorbed systemically when taken by mouth. (An injectable form of amphotericin-B is quite toxic, however, and its use is restricted to treatment of life-threatening systemic fungal infections.)

The oral form of amphotericin-B is very safe and non-toxic. Amphotericin-B is a more potent anti-yeast medicine than nystatin. Oral forms of pure amphotericin-B are presently available at only a few specialized compounding pharmacies in the United States. It has been approved by the FDA for use by mouth and was marketed in the U.S for many years in combination with tetracycline. That product was named Mysteclin-F. To treat yeast problems, you do not want the form that is combined with tetracycline.

Amphotericin-B in pure form for oral administration is can also be obtained at pharmacies in many other countries (often without a prescription). It is sold in France, on prescription only, under the brand name Fungizone, in 250 mg capsules. In Germany the prescription form is called Ampho-Moronal, as 100 mg tablets.

Patients recover more quickly and often remain well without further medication when amphotericin-B is combined with nystatin and Sporanox therapy. The best form of amphotericin-B is a powder inside 250 mg capsules (Fungizone is formulated in this manner). The capsules can be opened and emptied into the mouth four times daily, along with the nystatin, and mixed with the nystatin powder in the mouth.

+ "Triple therapy", the simultaneous daily administration of nystatin powder, amphotericin-B and either Sporanox or Diflucan, for at least two months, has led to lasting improvement in a large percentage of patients who had previously been resistant to therapy. Patients should continue all three medicines for two months and then continue with the dietary restrictions for another month, or for as long as progressive improvement continues to accrue.


***Quoted from http://drcranton.com/CFIDS.htm#CFIDS%20Paper%20it%20turned%20out%20to%20be%20my%20personal
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