Bio-films are an effective defense mechanism of both bacteria and viruses. A 2010 paper states “these extracellular infectious structures may protect viruses from the immune system and enable them to spread efficiently from cell to cell. “Viral biofilms” would appear to be a major mechanism of propagation for certain viruses. ” [2011 article] If you have reason to suspect that your CFS is related to EBV, HHV6 or other viruses, you should include treatment against biofilms. 60% to 85% of all microbial infections involve biofilms . Most, if not all, bacteria (and fungi) are capable of forming biofilms . There is evidence that HHV virus may use existing biofilms. Microorganisms growing in a biofilm are highly resistant to anti-microbial agents by one or more mechanisms .
If you break down bio-films, more infections may be exposed and symptoms may increase. This is commonly called die-off or a herxheimer reaction. At the same time, having the infection exposed means that both your immune system and anti-infection agents can kill off the infections.
Classic Biofilm Breakers
- N-acetylcysteine (NAC) is an effective biofilm breaker[Articles]. You should not take acetaminophen (Tylenol, Anacin-3) with it(it is used for overdoses of acetaminophen). Available as a supplement. It has a half-life of 6 hours suggesting one capsule per day. Given the long half-life, it may be taken within a few hours of any anti-infection agents.
- WARNING: This increases histamine release
Ethylenediaminetetraacetic acid (EDTA) is another effective biofilm breaker [ Articles]. It can make some antibiotics up to 1000x more effective. Available as a supplement. This decreases histamine release. It has a half-life (time for the blood concentration to become half) of 45 minutes which suggesting a capsule before each meal. It should be taken with any anti-infection agents.
Why is histamine release relevant? One model of CFS is that it caused by histamine intolerance (due to overproduction). Both Enterobacter and Klebsiella are known (major) overgrowth bacteria in CFS, and both are known to result in a high conversion of the essential amino acid histidine(found in eggs, chicken, beef, etc) to histamine. If you are interested in this, see my own blog  .
Always have the dosage and frequency of all supplements reviewed by a knowledgeable health professional before making any changes.
Herbal Biofilm Breakers
There are some herbs that have been demonstrated to inhibit biofilm formation. It appears that they are not as effective as the two supplements listed above.
- Ginger 
- Andrographis paniculata  – available from specialist online herbals
- Horseradish 
- Garlic – increases histamines
- Haritaki 
Pattern for Anti-biofilms and Anti-pathogens
Continuous anti-pathogens is no recommended by same CFS Physicians, in particular, Dr. Cecile Jadin, who applied a treatment protocol to CFS that was originally developed for occult rickettsia infections in Africa half a century ago. I discovered an interesting article from 2012 entitled “Optimal control strategies for disinfection of bacterial populations with persister and susceptible dynamics”.
“It is well-known that bacteria tend to attach to most surfaces and that this attachment becomes irreversible in the case of a biofilm colony. We have included transient attachment of the bacteria to the walls of the chemostat to incorporate this process. As the attachment rate increases, the time that it takes to eliminate the bacteria increases, which accords with intuition (since fewer bacteria are being washed out per unit time). Our results indicate that this makes constant dosing less effective since preventing growth (or keeping the bacteria in the persister state by never withdrawing the antibiotic) can eliminate the bacteria if they are washed out of the system.”
This is echoed in a 2008 article, Multidrug tolerance of biofilms and persister cells: “Other approaches to the problem include … cyclical application of conventional antimicrobials.”