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Antibiotics For Late Stage Lyme Disease

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Iv Antibiotic Regimen: Cephalosporin Plus Azole Plus Liposomal Cinnamon Clove And Oregano

Lyme Disease Treatment – Johns Hopkins (4 of 5)
  • 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.

Reasons To Choose Herbs

Plants have to deal with a wide range of microbes, including bacteria, viruses, protozoa, and fungi, just like any other living creature. Not having an immune system, plants deal with the problem by producing a sophisticated spectrum of biochemical substances called phytochemicals. Instead of one chemical, like an antibiotic, a medicinal herb contains hundreds of phytochemicals that suppress microbes in different ways therefore resistance is almost unheard of, even with very long-term use. Some herbs provide more potent antimicrobial properties than others. While herbs would never be a good choice for treating a life-threatening illness like pneumonia, they are perfect for suppressing stealth microbes associated with chronic illness.

Different herbs offer a slightly different range of benefits, therefore multiple herbs can be used together to cover for all possible stealth microbes involved. In fact, this is the preferred way of doing herbal therapy . This provides for a wide spectrum of activity against a wide range of microbial threats. You can think of it as an orchestra of healing the sum of multiple herbs is more powerful than each herb individually.

Over the millennia, humans naturally selected certain plant substances for use as medicines. These plants, now known as medicinal herbs, have chemistry that meshes well with human biochemistry. Not surprisingly, medicinal herbs are well tolerated by most people and can be safely used for extended periods of time.

Potential Treatment For Lyme Disease Kills Bacteria That May Cause Lingering Symptoms Study Finds

Screening thousands of drugs, Stanford scientists determined that in mice, azlocillin, an antibiotic approved by the Food and Drug Administration, eliminated the bacteria that causes Lyme disease.

Deer ticks are vectors of Borrelia burgdorferi, the bacteria that causes Lyme disease.Scott Bauer/USDA Agricultural Research Service

For decades, the routine treatment for Lyme disease has been standard antibiotics, which usually kill off the infection. But for up to 20% of people with the tick-borne illness, the antibiotics dont work, and lingering symptoms of muscle pain, fatigue and cognitive impairment can continue for years sometimes indefinitely.

A new Stanford Medicine study in lab dishes and mice provides evidence that the drug azlocillin completely kills off the disease-causing bacteria Borrelia burgdorferi at the onset of the illness. The study suggests it could also be effective for treating patients infected with drug-tolerant bacteria that may cause lingering symptoms.

This compound is just amazing, said Jayakumar Rajadas, PhD, assistant professor of medicine and director of the Biomaterials and Advanced Drug Delivery Laboratory at the Stanford School of Medicine. It clears the infection without a lot of side effects. We are hoping to repurpose it as an oral treatment for Lyme disease. Rajadas is the senior author of the study, which was published online March 2 in Scientific Reports. The lead author is research associate Venkata Raveendra Pothineni, PhD.

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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:

Hunting For Alternative Drug

Symptoms Of Lyme Disease In Humans

Frustrated by the lack of treatment options for Lyme disease patients with lingering symptoms, Rajadas and his team began hunting for a better alternative in 2011. In 2016, they published a study in Drug Design, Development and Therapy that listed 20 chemical compounds, from about 4,000, that were most effective at killing the infection in mice. All 20 had been approved by the Food and Drug Administration for various uses. One, for instance, is used to treat alcohol abuse disorder.

Jayakumar Rajadas

In this most recent study, azlocillin, one of the top-20 contenders, was shown to eclipse a total of 7,450 compounds because it is more effective in killing B. burgdorferi and causes fewer side effects. Lyme disease affects more than 300,000 people annually, according to the Centers for Disease Control and Prevention. It can affect various organs, including the brain, skin, heart, joints and nervous system, and cause heart problems and arthritis if untreated. Symptoms include fever, headaches, chills, and muscle and joint pain.

Traditional antibiotics, such as doxycycline, are effective as an early course of treatment for the infection in the majority of patients, but it remains unclear why these drugs fail to treat 10% to 20% of patients, Rajadas said.

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Why Antibiotics Have Limited Use For Chronic Lyme

Borrelia clears the blood quickly and uses its corkscrew shape to penetrate deeply into tissues where it is protected from antibiotics and the immune system. It can penetrate into cells, give up the corkscrew shape, and live inside of cells, thus gaining protection from the immune system and antibiotics. If confronted with a full antibiotic assault, it rolls up into dormant cyst and rides out the storm until the antibiotics are gone.

Antibiotics work best on highly threatening microbes that grow very rapidly and congregate densely in localized areas in the body . Borrelia grows very slowly in the body and only occurs in very low concentrations in tissues.

Borrelia is a master at blending in with the trillions of other microbes that make up the human microbiome . Overwhelming the host is not its mission it simply needs to scavenge enough resources to survive. Borrelias stealthy ability to lay low makes diagnosis and treatment a real challenge.

Borrelia never occurs alone. There are many stealthy microbes mycoplasma, chlamydia, Bartonella, Epstein-Barr virus , cytomegalovirus , and others that can occupy space in the microbiome. Sometimes they occur as coinfections with the tick bite, but they can already be present in the microbiome, without causing symptoms, when infection with Borrelia occurs.

Controversy : Validity Of Persistent Manifestations Being Attributable To Lyme Disease

Many patients report ongoing symptoms following treatment for Lyme disease, yet physicians disagree over the nature of these symptoms., Some physicians discount the likelihood that posttreatment symptoms are directly related to the earlier Lyme infection.,, This sentiment is expressed in articles with titles such as Dispelling the Chronic Lyme Disease Myth and in the often-stated phrase, I dont believe in chronic Lyme. Instead, the suggestion is that patients are simply reporting symptoms commonly seen in the general population or those of a secondary condition such as fibromyalgia or chronic fatigue syndrome.,

Other physicians hold that such symptoms are most likely directly attributable to the previous infection and represent treatment failure. This group notes that most of the reported posttreatment symptoms began before treatment and that the original Lyme diagnoses were, in part, based on their very existence.

Studies demonstrate that symptoms commonly reported by persistent Lyme disease patients occur more frequently in that group than in matched controls or an age-matched subset of the general population.,, For example, 41% of the subjects in Asch and colleagues study reported having arthritis. This is 5 times higher than the rate of arthritis in the general US population ages 18 to 44 years.

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Treatment For Other Forms Of Lyme Disease

People with other forms of disseminated Lyme disease may require longer courses of antibiotics or intravenous treatment with antibiotics such as ceftriaxone. For more information about treating other forms of Lyme disease, see:

The National Institutes of Health has funded several studies on the treatment of Lyme disease that show most people recover within a few weeks of completing a course of oral antibiotics when treated soon after symptom onset. In a small percentage of cases, symptoms such as fatigue and myalgia can last for more than 6 months. This condition is known as post-treatment Lyme disease syndrome , although it is also sometimes called chronic Lyme disease. For details on research into chronic Lyme disease and long-term treatment trials sponsored by NIH, visit the visit the National Institutes of Health Lyme Disease web siteexternal icon.

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What Is Lyme Disease

Alternative treatments for Lyme disease symptoms brings new hope to those suffering

Lyme disease is a bacterial infection. You get it when the blacklegged tick, also known as a deer tick, bites you and stays attached for 36 to 48 hours. If you remove the tick within 48 hours, you probably wonât get infected.

When you do get infected, the bacteria travel through your bloodstream and affect various tissues in your body. If you donât treat Lyme disease early on, it can turn into an inflammatory condition that affects multiple systems, starting with your skin, joints, and nervous system and moving to organs later on.

The chances you might get Lyme disease from a tick bite depend on the kind of tick, where you were when it bit you, and how long the tick was attached to you. Youâre most likely to get Lyme disease if you live in the Northeastern United States. The upper Midwest is also a hot spot. But the disease now affects people in all 50 states and the District of Columbia.

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What Are The Clinical Manifestations Of Ld

Clinical manifestations are divided into early, localized disease, and later disease.

Early, localized disease: Erythema migrans a rash at the site of a recent tick bite is the most common presentation in children and adults . EM typically develops seven to 14 days after a tick bite. EM is usually > 5 cm and mainly flat. There may be central clearing or some bluish discoloration but a classic bulls eye is uncommon. EM is usually asymptomatic but is not painful to the touch, like a cellulitis. EM can be confused with a localized hypersensitivity reaction from a tick or insect bite, which is usually swollen, smaller in size and pruritic). There can be either a single erythema migrans rash or multiple rashes without extracutaneous manifestations. However, fever, malaise, headache, mild neck stiffness, myalgia and arthralgia often accompany EM.

Without treatment, EM resolves spontaneously over a four-week period, on average.

Later disease: Approximately 20% of children with LD first present to a health care provider with extracutaneous signs or symptoms that are compatible with LD. These cases may also have a recent past history of EM lesions and non-specific low-grade fever, myalgia, and fatigue upon questioning further.

Figure 4) Erythema migrans rash showing the classic bulls eye form. Reproduced from reference 1 © All rights reserved. With permission from the Minister of Health, 2014

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Early Localized Lyme Disease

During this stage, the infection has not yet spread to other parts of the body. Diagnosing Lyme disease during stage 1 gives you the best chances of a quicker recovery.

Early localized Lyme disease commonly begins with a rash called erythema migrans. This rash, which occurs in 70% to 80% of infected people, typically develops seven days after a bite but can occur within three to 30 days.

The rash grows slowly over several days and can be more than 12 inches in diameter. The rash may be warm to the touch but is not usually painful or itchy. Some people may develop the classic bulls eye rash, but the rash’s appearance can vary greatly.

The following symptoms may also be present with or without a rash:

  • Joint or muscle pain
  • Swollen lymph nodes

People treated during this stage often recover quickly and completely. Treatment involves 10 to 14 days of oral antibiotics.

Unfortunately, 10% to 25% of cases may go unnoticed and progress to later stages of the disease.

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For Depression And Anxiety

Both psychotherapy and pharmacotherapy have proven benefits for improving mood. Psychotherapy has many different types such as supportive, dynamic, cognitive behavioral, dialectical behavior therapy, transference focused psychotherapy each of which offers benefit. Pharmacotherapy also has many different types. For depression the first-line options usually are SSRIs, SNRIs, Tricyclics or other agents with more unique modes of action.

A few noteworthy tips on anti-depressant agents:

  • Most anti-depressant agents also help in reducing anxiety. However the opposite isn’t necessarily true. Specific anti-anxiety agents such as clonazepam or diazepam may not necessarily help fight depression.
  • Most anti-depressants take three to eight weeks before an effect is seen. Therefore, it is unwise to stop an anti-depressant after only three or four weeks, as staying on it another two to three weeks may lead to a good response.
  • Dosage makes a difference. Some anti-depressants work fine at low doses some medications however are effective only at higher doses. Some medications are more effective as the dose is increased. Other antidepressants may have a therapeutic range one has to achieve at least a certain dosage .

Herbal And Rx Antimicrobials That Treat Persisters

Lyme Disease: Symptoms and Treatment

This is a newer area in Lyme treatment. To help justify these various antimicrobial options, I describe the experimental basis behind my recommendations. These options are ones I am using with various degrees of success in my Seattle practice. They all have either laboratory experiments supporting their use or published human experiments.

Laboratory-Based Experiment Options

Here is a list of prescription and herbal medicine options shown in lab experiments to kill persisters that I am incorporating into my treatments of Lyme and/or Bartonella.

  • Disulfiram – work slowly up to 4 to 5 mg/kg body weight 1 time a day.
  • Methylene Blue 50 mg 2 times a day.
  • Liposomal Oregano, Cinnamon, and Clove Oils 1 capsule 2 times a day.
  • Cryptolepis 5 ml 3 times a day.
  • Japanese Knotweed½ tsp 3 times a day – start at ¼ tsp 1 time a day and then increase after two weeks to ½ tsp 3 times a day.
  • Cats Claw 30 drops 2 times a day.

Human-Based Experiment Options

Here is a list of prescription medications shown in human experiments to help with persister Lyme.

  • Disulfiram – work slowly up to 4 to 5 mg/kg body weight 1 time a day.
  • Dapsone – work up to 100 mg or 200 mg 1 time a day.

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Treatment Approach To Chronic Lyme Disease

What is the approach for a patient who presents with persistent symptoms of Lyme disease ? First, the Lyme Western blot should be repeated, and coinfection testing should be performed by a laboratory that is proficient in tickborne disease analysis. At the same time, other medical problems that could cause persistent symptoms should be ruled out. Measurement of the CD57 natural killer cell level, which is an immunologic marker that can be used to monitor treatment in chronic Lyme disease, should be performed . If neurologic symptoms are severe, a single-photon emission CT SPECT brain scan should be obtained, to see how much inflammation is present in the brain. Neuropsychiatric evaluation may also be helpful .

On the basis of these results, coinfections should be treated first, if any are present, and then oral or parenteral antibiotics should be used to treat symptoms of persistent Lyme disease. Antibiotic therapy should be administered in a rotating and open-ended manner, in conjunction with probiotics, to minimize adverse effects . Monitoring of clinical symptoms, CD57 natural killer cell levels, and markers of inflammation should be performed in conjunction with treatment .

Precedents for prolonged antibiotic therapy.

Racial Differences In Incidence

Lyme disease is reported primarily in whites, although it occurs in individuals of all races. No genetic explanation is known for this the disparity most likely stems from social or environmental factors and possibly to the fact that erythema migrans is more difficult to diagnose in dark-skinned individuals.

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My Chronic Lyme Disease Journey

Updated 7/22/22

Likely, you have come to this page in hopes of sorting out some of the confusion surrounding Lyme disease.

There is so much controversy around this disease because most doctors dont understand it. Even many doctors who consider themselves Lyme experts or Lyme literate medical doctors do not completely comprehend its complexities.

But I have one qualification that most other physicians do not. My life and a busy medical career were disrupted midstream by Lyme disease, though obtaining that diagnosis was quite the journey through multiple diagnoses including fibromyalgia.

My late 40s were marked by debilitating fatigue, tremendous brain fog, aching all over, burning in my feet and tingling in my hands, skin rashes, joint pain, chest pain, heart palpitations, mood changes, and poor sleep. I know what its like to start and end every day feeling like you have a terrible flu. Over several years, I experienced virtually every known symptom of Lyme disease.

Ultimately, this caused me to stop practicing obstetrics. But because I didnt have a firm diagnosis at the time, declaring disability wasnt an option. As an alternative, I started a less demanding primary care practice that did not require nightcall. The practice provided me with the environment I needed to recover. I had control over my work hours and the intensity of the work.