Table 1.

Medication and nutritional supplementation that were used during high dose pulsed dapsone combination therapy.

Time Frame on HDD CT	Medication	Nutritional Supplementation
Days 1 + 2 (pre-HDD CT)	Methylene blue 50 mg BID Continue prior medication for Lyme and associated tick-borne disease, other medical conditions	Triple biofilm agents (Biocidin, 2 sprays BID; Stevia, 15 drops BID; cinnamon/clove/oregano oil capsules, 1 PO BID). If on DSF, monolaurin 1 scoop/day and serrapeptase 2 capsules PO BID are substituted for Biocidin and Stevia. Triple probiotics (Theralac, 1 PO BID, Orthobiotic 1 PO BID; saccharomyces boulardii, 1 PO BID) NAC 600 mg PO BID; Alpha lipoic acid 600 mg PO BID; glutathione 1000 mg PO BID
Days 3 + 4 (pre-HDD CT)	Methylene blue 100 mg in the am Methylene blue 50 mg in the pm	Same as days 1 + 2
Days 5–8, HDD CT	Doxycycline 200 mg PO BID with meals (or Minocycline, up to 100 mg BID); hydroxychloroquine 200 mg PO BID with meals; rifampin 300 mg, 2 PO BID before meals; Nystatin 500,000 units 2 PO BID with meals; dapsone 100 mg, 2 PO BID with meals; methylene blue 100 mg PO BID with meals; leucovorin 25 mg, 3 PO BID with meals	Same as days 1 + 2, plus add L-methyl folate 15 mg, three PO BID, and increase glutathione to 2000 mg PO BID
Days 9–12 (post-HDD CT)	Stop all medication except methylene blue 100 mg PO BID and Leucovorin 25 mg, 3 PO BID	Same as days 5–8
Days 13–15 (post-HDD CT)	Decrease leucovorin to 2 PO BID and decrease methylene blue to 50 mg PO BID.	Same as days 5-8, except decrease L-methyl folate to 2 PO BID; decrease glutathione to 2000 mg PO QD.
Days 16–22 (week 3, post-HDD CT)	Stop methylene blue, decrease leucovorin to 25 mg PO BID	Probiotics are decreased to once a day; L-methyl folate is decreased to one PO BID; Glutathione is decreased to 500 mg twice a day (1000 mg total).
Week 4 (days 23 +)	Decrease leucovorin to 25 PO QD	Decrease L-methyl folate to one QD

We monitored patient symptoms at each follow-up consultation (q 1–2 months) including changes in eight major symptoms before and after HDDCT, side effects (clinical, laboratory) and subjective percentage of normal from baseline functioning. The number of pulsed HDDCT treatments varied based on response rates. Those who had significant clinical improvement without a relapse of underlying symptoms including fatigue, joint/muscle pain, headaches, neuropathy, insomnia, cognition, and sweating after one course of HDDCT remained off all antibiotic therapy. Those who demonstrated some clinical improvement but continued to have ongoing symptoms post-HDDCT, without any significant adverse side effects, did one to two more courses of HDDCT at least one month apart until reaching a plateau with no further improvement in eight major Lyme symptoms related to their CLD/PTLDS.