Delayed Diagnosis Prolonged Symptoms
People often dont realize that a tick has bitten them. Or they may not develop the characteristic bullseye-shaped rash that would lead them to seek medical care sooner.
So, weeks or months may have passed by the time people show up at the doctors office with more severe symptoms, such as heart problems, headaches, pain, or weakness.
Study author Monica Embers, PhD, assistant professor of microbiology and immunology at Tulane University School of Medicine, said in a press release that although antibiotics help many people with Lyme disease, standard treatment may not be enough when diagnosis is delayed.
Dr. Samuel Shor, president of the International Lyme and Associated Diseases Society, points to the study as evidence that a low-level persistent infection may be behind the long-term symptoms that some people treated for Lyme disease experience.
The problem is that the organism has the potential capacity to continue to infect multiple areas of the body and ultimately result in what we characterize now as chronic Lyme disease, Shor told Healthline.
As officials at the Centers for Disease Control and Prevention point out, chronic Lyme disease is a term that is not used the same by everyone.
Its often used to describe lingering symptoms after Lyme disease treatment. But some people also use it to describe those symptoms even when there is no evidence that a person has had a B. burgdorferi infection.
Fatigue, in particular, is a difficult symptom to study in animals.
The Treatment Of Early Lyme Disease
Christie Choo-Kang, PharmD, BCPSNephrology and Renal Transplant Clinical SpecialistBoston Medical Center
Eileen Tang, PharmD Candidate 2011College of Pharmacy and Allied Health Professions, St. John’s UniversityNew York, New York
Arun Mattappallil, PharmD Candidate 2011College of Pharmacy and Allied Health Professions, St. John’s UniversityNew York, New York
US Pharm.
Lyme disease, also known as Lyme borreliosis, is the most common vector-transmitted illness in the United States.1,2 The disease was first recognized in 1975 in a number of children in Lyme, Connecticut, who were initially diagnosed with juvenile rheumatoid arthritis because of overlapping signs and symptoms.1 In 1982, Willy Burgdorfer, PhD, discovered that a spirochete isolated from Ixodes scapularis, a deer tick, was the same spirochete found in patients with Lyme disease.
Confirmed cases of Lyme disease are defined as erythema migrans greater than 5 cm in diameter or one or more objective late manifestations of Lyme disease with laboratory confirmation in patients with possible exposure to ticks. Healthy People 2010 set a goal of a 44% decrease in the incidence of Lyme disease by 2010. Since 2000, the CDC has contributed more than $3.5 million per year for new research on Lyme disease.2
Herbal And Prescription Antimicrobials By Function
Be aware the doses I provide below are for adults. These same prescriptions can be used with children but have lower doses. For pediatric dosing, talk with your family physician or pediatrician. Tetracyclines can be used in children under eight, but there is a risk of tooth staining. This staining seems not to be an issue if they are used for a month or less.
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What If Lyme Disease Treatment Goes On For Years
While the media and the Internet tend to report the very worst cases of Lyme disease, about 80 percent of people who get the disease get over it in a few weeks. In 10 to 20 percent of people who have Lyme disease, however, the symptoms go on for months or years.
Other studies have looked at long-term antibiotic therapy for Lyme disease. The Persistent Lyme Empiric Antibiotic Study Europe study involved 280 people who had symptoms, on average, for 2-1/2 years. These were people who had had the bulls eye rash or persistently achy joints or other symptoms of Lyme disease for years, but who had not been diagnosed at the likely time of the tick bite. Everyone was given Rocephin by IV for 14 days to âknock outâ the infection, and then they were given the same treatment options as the groups mentioned above. When symptoms were longstanding, doxocycline was superior in controlling Lyme disease to placebo, but not by much, and about half the people who received antibiotics had problems with diarrhea, nausea, or allergic rashes. These problems did not occur in the placebo group.
What Is Lyme Arthritis
Lyme arthritis occurs when Lyme disease bacteria enter joint tissue and cause inflammation. If left untreated, permanent damage to the joint can occur. Lyme arthritis accounts for approximately one out of every four Lyme disease cases reported to CDC. Because of reporting practices, this statistic may overstate the frequency of arthritis among patients seen in routine clinical practice.
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Antimicrobials That Kill Growing Phase Cysts
Intracellular and Extracellular
Note: I work with the following agents as anti-cyst agents based on the mechanism by which these antibiotics work and some scientific experiments. For the Rifamycins, there are no laboratory experiments showing these agents work against cysts. Clinically, I see great benefit in using the Rifamycins as my anti-cyst agents – so I list them here.
Rifamycins
- Rifampin 300 mg 2 pills 1 time a day or 1 pill 2 times a day
- Rifabutin 150 mg 2 pills 1 time a day
Azoles
- Tinidazole 500 mg 1 pill 2 or three times a day usually pulsed for four days on then three days off of each 7 days
- Metronidazole 500 mg 1 pill 2 or three times a day usually pulsed for four days on then three days off of each 7 days.
Herbal
- Grapefruit seed extract 250 mg 1 pill 2 times a day. Note this is an herbal antibiotic that I find as effective as the prescription options in this list.
Treatment For Chronic Lyme Disease
Sometimes, people go through treatment for Lyme disease but their symptoms donât go away. If this lasts over 6 months, itâs known as chronic Lyme disease or âpost-treatment Lyme disease syndromeâ .
Doctors still arenât sure why some people get PTLDS. Some believe that getting Lyme disease may cause damage to your tissues or immune system. Others believe itâs because the bacteria that causes Lyme hasnât completely gone away.
There is little evidence that taking more antibiotics at this stage will help. They may actually be harmful. Instead, your doctor will focus on treating the symptoms youâre still having. This will be different for everyone. Some people could benefit from a medicine that relieves fatigue, while others may need a drug that can help with headaches or very sensitive skin.
Your doctor could also have you try a treatment that helps people with chronic fatigue syndrome or fibromyalgia.
More research is needed to figure out how best to treat PTLDS. Itâs something that can be frustrating. Just remember: Many people who have this condition do start feeling like their old selves after a few months.
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What Is Post Treatment Lyme Disease
Post Treatment Lyme Disease represents a research subset of patients who remain significantly ill 6 months or more following standard antibiotic therapy for Lyme disease. PTLD is characterized by a constellation of symptoms that includes severe fatigue, musculoskeletal pain, sleep disturbance, depression, and cognitive problems such as difficulty with short-term memory, speed of thinking, or multi-tasking. In the absence of a direct diagnostic biomarker blood test, PTLD has been difficult to define by physicians, and its existence has been controversial. However, our clinical research shows that meticulous patient evaluation when used alongside appropriate diagnostic testing can reliably identify patients with a history of previously treated Lyme disease who display the typical symptom patterns of PTLD.
Antibiotics For Lyme Disease
How long to treat patients with Lyme remains an issue of controversy. With traditional antibiotic therapy, lasting 2-4 weeks, 10-20% of patients will have ongoing symptoms including fatigue, joint pain, insomnia and complaints of brain fog. Indefinite long-term treatment is advocated by ILADS , based on a patients symptoms. In contrast, IDSA only recommends 2-4 weeks’ treatment. The two groups are bitter adversaries.
A new study supports short-course treatmentbut is not entirely above criticism.
This study from the Netherlands, reported in the New England Journal of Medicine, was well designed, being randomized and double blind, and with a quasi-placebo group .
The upshot: There were no differences in the outcomes of the three treatment groupsbut some lingering questions remain. Notably, a large percentage of patients had side effects from the antibiotics, some quite serious.
Why is this important?
Lyme has been increasing, especially in the northeastern and upper Midwest portions of the U.S. The CDC now estimates there are about 300,000 cases of Lyme each year, with 30,000 reported cases.
But Lyme can be difficult to diagnose, and the assays miss a lot of patients . So if 20% of patients are left with persistent symptoms, that means that 60,000 people per year are being left with untreated problems that we just dont know what to do with. This study, along with others before it, suggests that longer antibiotics are not the answer.
The fine print:
Study Findings:
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Antimicrobials That Kill Growing Phase Spirochetes
Extracellular
Penicillins
- Amoxicillin 500 mg 1 to 2 pills 3 times a day. Alternatively as an alternative to IV antibiotics take 3 to 4 pills 3 times a day.
- Amoxicillin/Clavulanic Acid 875 mg/125 mg 1 pill 2 times a day
- Bicillin LA 2.4 million units IM 3 times a week with one day between each injection
Cephalosporins
- Ceftriaxone 2 gm IV 2 times a day for 4 days in a row then off for 3 days of each 7 days
- Cefotaxime 2 gm IV every 8 hours
- Cefuroxime 500 mg 1 pill 2 times a day
- Cefdinir 300 mg 1 pill 2 times a day
Additional IV Antibiotics
Vancomycin, imipenem, and ertapenem are possible alternatives if someone is allergic to Ceftriaxone or Cefotaxime.
Intracellular and Extracellular
- Clarithromycin 500 mg 2 pills 2 times a day
- Azithromycin 500 mg 1 time a day or 500 mg IV 1 time a day
Tetracyclines
- Doxycycline 100 mg 1 or 2 pills 2 times a day or 200 to 400 mg mg IV 1 time a day
- Minocycline 100 mg 1 pill 2 times a day
How Is It Treated
An initial episode of Lyme arthritis should be treated with a 4-week course of oral antibiotics. Patients with persistent joint inflammation and pain after the first course of antibiotics may require a second course . In some cases, joint swelling and pain can persist or recur after two courses of antibiotics. The cause of persistent arthritis is unknown but is thought to be driven by immunologic factors. Additional antibiotics have not been shown to improve these symptoms, and patient referral to a rheumatologist should be considered.
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Tobacco To Turn Off Ticks
Birds get ticks, too. The house finch has developed a strategy to fight ticks. A study in the Avian Biology journal has shown that breeding house finches use cigarette stubs to âproofâ their nests. The nicotine wards off parasites, but sadly the neurotoxin can also have negative effects on the chicks.
Ticks â a plague for humans and animals alike
Postlyme Disease Symptoms And Syndrome
The outcome of treatment in most patients with erythema migrans is excellent. Studies show, however, that when questioned at 6 months or more aftertreatment of erythema migrans, approximately 10% of patients will report purely subjective symptoms such as fatigue or musculoskeletal pains.17 These subjective symptoms are typically mild and may wax and wane in intensity. Patients who have them are referred to as having postLyme disease symptoms or syndrome, depending on the symptom duration and severity. The cause of these symptoms is currently unknown. Carefully done microbiologic evaluations in the United States have failed to find evidence of either persistentB. burgdorferi infection or a coinfection with a secondIxodes-transmitted pathogen. In patients with persistent symptoms attributed to Lyme disease, longer-term antibiotic treatment has been shown to have no additional beneficial effects on health-related quality of life beyond those with shorter-term treatment.A4 Furthermore, retreatment has provided either no measurable benefit or a benefit so modest or ambiguous that it was outweighed by the risks associated with the antibiotic therapy.17b Therefore, symptomatic treatment is recommended for such patients.
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Clinical Judgment And Shared Decision
- Given the number of clinical variables that must be managed and the heterogeneity within the patient population, clinical judgment is crucial to the provision of patient-centered care.
- Based on the GRADE model, ILADS recommends that patient goals and values regarding treatment options be identified and strongly considered during a shared decision-making process.
Lyme Disease Antibiotic Combination Examples
In my experience, I find the prescription antibiotic combinations below work 85 to 90 percent of the time. The herbal combination options help 85 to 90 percent of the time. I find all these combinations more successful than the Andrographis/Japanese knotweed/cats claw combinations that some like herbalist Stephen Harrod Buhner and Bill Rawls, MD, recommend. The Buhner/Rawls combination helps about 60 to 65 percent of the time in my clinical observations. To reach the success rates I describe here, it is essential to follow the first ten steps of The Ross Lyme Support Protocol to support the immune system.
Key Points: Each combination
- Combines antibiotics to treat all forms of the germ.
- Combines antibiotics to treat Lyme living outside and inside of cells.
- Combines antibiotics that work in different ways to attack the germ from different angles.
- Treats all growth phases of Lyme at the same time – this means treatments include antimicrobials that address persisters in addition to the growth phase of the term.
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Antimicrobial Herbs That Kill Growing Phase Spirochetes & Cysts
Intracellular and Extracellular
Based on my observations, these herbal combination options have as good of a chance as the prescription options. They appear to kill intracellular and extracellular Lyme too based on the clinical benefit I see in my medical practice.
- Cats Claw and Otoba Bark Tinctures 30 drops of each 2 times a day. Start at 5 drops 2 times a day and add 1 drop per dose per day until you reach 30 drops 2 times a day. If you get a Herxheimer reaction, stop increasing the dose until it has passed.
- Cats Claw and Japanese Knotweed 30 drops of Cats Claw 2 times a day and ½ tsp of Japanese Knotweed 3 times a day. Work up to these doses over 30 days. Start Cats Claw at 5 drops 2 times a day and add 1 drop per dose per day until you reach 30 drops 2 times a day. Start the Japanese Knotweed at ¼ tsp 3 times a day and in two weeks increase to ½ tsp 3 times a day.
Iv Antibiotic Regimen: Cephalosporin Plus Azole Plus Liposomal Cinnamon Clove And Oregano
- ceftriaxone 2 gm IV 2 times a day for 4 days on and 3 days off
- tinidazole 500 mg taken orally 1 pill 2-3 times a day for 4 days on and 3 days off in 7-day cycles
- liposomal cinnamon, clove, and oregano capsules 1 pill 2 times a day
Key Points:
- Various antibiotics can be used as IV. I use this one most commonly because it is the easiest to administer and one of the lowest cost IV regimens. The ceftriaxone is given in a syringe and injected over 10 minutes. This is also a pulse dose regimen . Ceftriaxone could be given daily instead as 2 gm IV 1 time a day.
- I have found various pulse dose regimens of tinidazole to work. These include 2 weeks on and 2 weeks off or in the regimen seen here.
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Why This Case Was Significantly Important As An Emerging Infection
Lyme borreliosis is the most common tick-borne disease of pronounced public health importance in countries with moderate climate in the Northern Hemisphere.1 Its increasing incidence1,2 may be a consequence of a range of environmental factors, together with changing human behavior.3 Unfortunately, LB has become a misdiagnosis also for non-specific chronic symptoms such as arthralgias, myalgias, headache, and fatiguesymptoms frequently present in the general population. The diagnosis of LB is too often based on erroneous interpretations of microbiological test results, whereas patients with typical clinical signs may stay undiagnosed and untreated.
Linda K. Bockenstedt, in, 2017
Macrolide Plus Grapefruit Seed Extract Plus Cryptolepis
- clarithromycin 500 mg 1 pill 2 times a day
- grapefruit seed extract 250 mg 1 pill 2 times a day.
- cryptolepis 5 ml 3 times a day
Key Points:
- Grapefruit seed extract is better tolerated than both tinidazole and metronidazole and supports killing of Lyme cysts.
- Cryptolepis can treat persister and growing Lyme. If a person also has Babesia, cryptolepis can treat this too.
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Are There Alternative Treatments For Lyme Disease
There are a variety of alternative treatments aimed at patients who believe they may have Lyme disease. But the effectiveness of these treatments is not supported by scientific evidence, and in many cases they are potentially harmful.
Bismacine, also known as chromacine, is an alternative-medicine drug that some people use to treat their Lyme disease.
The Food and Drug Administration warns that people should not use this injectable product, which has reportedly caused hospitalization and at least one death. 70563-1.pdf” rel=”nofollow”> 6)
In addition, the FDA notes that bismacine contains high levels of bismuth, which can cause heart and kidney failure.
Other alternative treatments include oxygen therapy, light therapy, and a variety of nutritional or herbal supplements. But there is no evidence that these treatments are clinically effective in the treatment of Lyme disease.
What To Try If You Have Failed Years Of Antibiotics
In my practice for those that have failed years of regular antibiotics I offer two persister oriented regimes. Both of these regimens have some published clinical evidence of benefit. One regimen I offer is a Horowitz dapsone persister regimen. The other option I offer is a disulfiram only regimen or a disulfiram combination regimen . You can read more details about how to take both of these regimens in
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