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Both of these approaches increase the permeability of the bacterial membrane, stimulate drug uptake, increase the achievable intracellular concentration of antibiotic drugs and thereby increase bactericidal efficacy (See Fig

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Liu Y, Jiang JJ, Du SY, Mu LS, Fan JJ, Hu JC, et al

doi:10.1113/JP287535 Dahl K, et al

Repeat generally twice per week for maximum benefits, however some patients find 3x weekly more beneficial

Biguanides (metformin): Medications used to treat type 2 diabetes, metabolic syndrome, nonalcoholic fatty liver disease, and polycystic ovary syndrome can lead to decreased vitamin B12 absorption (5)