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
Q: I’m Achy And Tired All The Time Could I Have Lyme Disease
The answer is yes, possibly. When a patient comes into my clinic for the first time, I take down their clinical history. If I suspect tickborne disease, I ask if they’ve been exposed to ticks or tick habitats. Have they observed any rashes? The typical Lyme rash expands and is ringlike, usually not itchy or painful. If it’s under a person’s hairline, between the toes, or on the back of the body, it may not be noticed. At least 21% of Lyme patients, and probably more than 50%, never see a tick or a rash.
Early Lyme patients present with flu-like symptoms. Tick bites and resulting symptoms often occur in the summer, but in my California practice, Lyme season may overlap with the fall/winter flu season, confusing the diagnostic picture.
Next, I do a complete physical exam, with an emphasis on neurological deficits, such as loss of balance, tremors, facial asymmetry , and asymmetric reflexes. Then, I ask about the progression of their symptoms over time. In the first few months of Lyme disease, patients often experience malaise, fatigue, mild to severe headaches, nerve pain or tingling in the hands or feet, all in a relapsing-remitting course. In other words, the symptoms wax and wane.
How You Get Lyme Disease
If a tick bites an animal carrying the bacteria that cause Lyme disease, the tick can become infected. The tick can then transfer the bacteria to a human by biting them.
Ticks can be found in any areas with deep or overgrown plants where they have access to animals to feed on.
They’re common in woodland and moorland areas, but can also be found in gardens or parks.
Ticks don’t jump or fly. They climb on to your clothes or skin if you brush against something they’re on. They then bite into the skin and start to feed on your blood.
Generally, you’re more likely to become infected if the tick is attached to your skin for more than 24 hours. Ticks are very small and their bites are not painful, so you may not realise you have one attached to your skin.
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Lyme Disease Antibiotics Overview
The following are four general rules I use to develop a Lyme disease antibiotic regimen.
- Rule 1. Combine antibiotics to treat all forms of the germ.
- Rule 2. Combine antibiotics to treat Lyme living outside and inside of cells.
- Rule 3. Combine antibiotics that work in different ways to attack the germ from different angles.
- Rule 4. Treat all growth phases of Lyme at the same time – this means treatments should include antimicrobials that address persisters in addition to the growth phase of the term.
Symptoms Of Post Treatment Lyme Disease
- Include severe fatigue, musculoskeletal pain, & cognitive problems
- Can significantly impact patients health and quality of life
- Can be debilitating and prolonged
Our research indicates the chronic symptom burden related to PTLD is significant. Although often invisible to others, the negative impact on quality of life and daily functioning is substantial for PTLD sufferers.
The chronic symptom burden related to Lyme disease is considerable, as shown on the left side of the graph above, and statistically significantly greater than the aches and pains of daily living experienced by the control group, on the right.
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How Do Patients Respond To Treatment
We looked at patients with chronic Lyme diseasethose who remained ill for six or more months following treatment with antibiotics for Lyme disease . The first thing we did was identify different patients as well, high responders, low responders, or non-responders. Well patients responded positively to a survey question asking if they were well or remained ill. Those who remained ill were asked whether their condition had changed as a result of treatment. Those who said they were unchanged or worse were categorized as non-responders. Patients who said that they were better or worse following treatment, were asked how much better or worse. Those who had improved substantially were deemed high responders.
59% of patients had improved with treatment and 42% were either well or high responders. The focus of our study was on this latter group. You might wonder whether 42% response is considered good compared to other drugs. Heres what the prior head of GlaxoSmithKline said about treatment effectiveness rates of drugs in general .
The vast majority of drugs more than 90 per cent only work in 30 or 50 per cent of the people. Drugs out there on the market work, but they dont work in everybody. Dr. Allen Roses, GlaxoSmithKline
So you can see that a 42% rate of substantial improvement is within the range of most drugs on the market.
What Are The Side Effects Of Lyme Disease Treatments
Antibiotics, like all medications, have the potential for side effects. Any antibiotic can cause skin rashes, and if an itchy red rash develops while on antibiotics, a patient should see their physician. Sometimes symptoms worsen for the first few days on an antibiotic. This is called a Herxheimer reaction and occurs when the antibiotics start to kill the bacteria. In the first 24 to 48 hours, dead bacterial products stimulate the immune system to release inflammatory cytokines and chemokines that can cause increased fever and achiness. This should be transient and last no more than a day or two after the initiation of antibiotics.
The most common side effect of the penicillin antibiotics is diarrhea, and occasionally even serious cases caused by the bacteria Clostridium difficile. This bacterial overgrowth condition occurs because antibiotics kill the good bacteria in our gut. It can be helpful to use probiotics to restore the good bacteria and microbiome balance.
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If Bitten By A Tick Should I Consider Immediate Antibiotics To Prevent Lyme Disease
ILADS recommends that prophylaxis be discussed with all who have had a blacklegged tick bite.An appropriate course of antibiotics has been shown to prevent the onset of infection.
When the decision is made to use antibiotic prophylaxis, ILADS recommends 20 days of doxycycline . The decision to treat a blacklegged tick bite with antibiotics often depends on where in the country the bite occurred, whether there was evidence that the tick had begun feeding, and the age of the person who was bitten. Based on the available evidence, and provided that it is safe to do so, ILADS recommends a 20-day course of doxycycline.
Patients should also know that although doxycycline can prevent cases of Lyme disease, ticks in some areas carry multiple pathogens, some of which, including Babesia, Powassan virus, and Bartonella, are not responsive to doxycycline. This means a person could contract a tick-borne illness despite receiving antibiotic prophylaxis for their known tick bite.
ILADS recommends against single-dose doxycycline. Some doctors prescribe a single 200 mg dose of doxycycline for a known bite. However, as discussed in detail in the guidelines, this practice is based on a flawed study that has never been replicated. Read more in the ILADS treatment guidelines.
The bottom line: If you have been bitten by a blacklegged tick, you should discuss immediate antibiotic treatment with your provider as a possible course of action.
How Is Lyme Disease Treated
Lyme disease is most often treated with antibiotics such as doxycycline, amoxicillin, or cefuroxime for several weeks. Please complete the full course of antibiotics as prescribed, even if your child is feeling better, in order to kill all the bacteria.
If your child doesn’t respond to oral antibiotics, or if the Lyme disease is affecting the central nervous system, antibiotics may need to be given intravenously . This usually doesnt require your child to be hospitalized. In many cases, a nurse can come to your home to administer the IV or teach you or another family member how to do it.
Anti-inflammatory medicine may be prescribed for children who are experiencing pain from arthritis.
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If I Take Antibiotics To Prevent Lyme And Then Have A Negative Test Am I Lyme
If you do receive prophylactic treatment, be cautious in in interpreting the results of subsequent testing. Widely-used blood tests look for antibodies to Borrelia burgdorferi, but early treatment can prevent the body from mounting an antibody response. Should you become infected despite prophylactic treatment, subsequent tests results couldbe falsely negative.
Critical Appraisal Of Individual Studies
The included systematic review was critically appraised by one reviewer using AMSTAR II, the non-randomized study was assessed using the ROBINS-I Tool, and guidelines, were assessed with the AGREE II instrument. Summary scores were not calculated for the included studies rather, a review of the strengths and limitations of each included study were described narratively.
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Questions To Ask Your Doctor
- I found a tick embedded in my skin, but I cant get it out. What should I do?
- Ive been bitten by a tick. Do I need to be seen?
- Do I need a blood test to confirm Lyme disease?
- Which antibiotic is best for me?
- How long will I have to take the antibiotic?
- What tick or insect repellent should I use for me or my child?
- How long will the symptoms last?
- What should I do if I still dont feel well a long time after I was bitten?
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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What Are The Signs And Symptoms Of Lyme Disease
Lyme disease has three stages. Not everyone experiences all symptoms. Children treated with antibiotics in the early stage almost never develop late stages of the disease.
- In about 70 per cent of children with early Lyme disease: A circular or oval expanding pink or red rash called erythema migrans at the site of a recent tick bite. The rash can be more than 5 cm across, and almost always develops from 3 to 30 days after a tick bite. Unlike skin infections, it is usually painless.
- Fever, general discomfort, headache, mild neck stiffness, muscle and/or joint pain may be present with or without the rash.
- Blood tests for Lyme disease should not be done in the early stages, because they are usually negative. If someone has been in area with known Lyme disease and develops a rash that is thought to possibly be erythema migrans, they should be treated with antibiotics that work for Lyme disease. A person who has no rash but has other possible signs or symptoms of Lyme disease after a tick bite should see a doctor.
Second stage, when the bacteria spread in the body:
- Multiple erythema migrans rashes may appear several weeks after the tick bite.
- Facial paralysis may appear as weakness in the muscles of one side of the face , often noticed as an uneven smile.
- Meningitis may appear with fever, headache, stiff or sore neck.
- Heart disease is rare, especially in children.
Post-Lyme disease persistent symptoms:
Living With Lyme Disease
Most people treated in the early stages of Lyme disease make a quick and complete recovery. Some may experience symptoms for a few weeks after treatment. If you were treated for Lyme disease but you still dont feel well, call your family doctor. He or she can make sure there isnt something else wrong. They can help you find ways to ease your symptoms. Some patients have found relief with treatments typically used for chronic fatigue syndrome or fibromyalgia.
Other things you can do to help manage Lyme disease include:
- Educate yourself.There is a lot of inaccurate information to be sorted through, especially on the internet. Ask your doctor if you have questions.
- Track your symptoms.Keep a diary of your sleep patterns, eating habits, exercise routines, and how youre feeling. You or your doctor may be able to make connections between them.
- Take care of yourself.Eat a healthy diet. Exercise as regularly as you can. Get plenty of rest.
Find support. It can be hard to not feel well and not know why. Some people may think your symptoms arent real. Talk to friends and family. If they cant offer support, talk with a counselor who can help you.
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Quinine Derivatives To Boost Intracellular Antibiotics
Inside of cells, Lyme may live in cave-like structures called vacuoles. In these vacuoles, Lyme germs create a hostile acidic environment that can limit the effectiveness of various antibiotics. Quinine derivatives, like hydroxychloroquine , can make the inside of cells more basic which can help the tetracyclines and macrolides mentioned above work better.
- Hydroxychloroquine 200 mg 1 pill 2 times a day
How Is It Treated
The main treatment for Lyme disease is antibiotics. These medicines usually cure Lyme disease within 3 weeks of starting treatment.
It’s important to get treatment for Lyme disease as soon as you can. If it goes untreated, Lyme disease can lead to problems with your skin, joints, nervous system, and heart. These can occur weeks, months, or even years after your tick bite. The problems often get better with antibiotics, but in rare cases they can last the rest of your life.
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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
- 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.
Penicillin Plus Azole Plus Lipsomal Cinnamon Clove & Oregano Oil
- amoxicillin 500 mg 4 pills 3 times a day
- tinidazole 500 mg 1 pill 2 or 3 times a day for 4 days on and 3 days off in 7-day cycles.
- liposomal cinnamon, clove, and oregano oil capsules 1 pill 2 times a day.
- This is a very high dose of amoxicillin, which is four times stronger than physicians prescribe for other infections like ear infections. I consider this dose to be nearly as effective as IV antibiotics.
- This is a pulse dose regimen of the tinidazole. It may be more effective than continuous regimens.
- The essential oils are added to treat persister Lyme.
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Why Are Antibiotics The First Line Of Treatment For Lyme Disease
The use of antibiotics is critical for treating Lyme disease. Without antibiotic treatment, the Lyme disease causing bacteria can evade the host immune system, disseminate through the blood stream, and persist in the body. Antibiotics go into the bacteria preferentially and either stop the multiplication of the bacteria or disrupt the cell wall of the bacteria and kill the bacteria . By stopping the growth or killing the bacteria the human host immune response is given a leg up to eradicate the residual infection. Without antibiotics, the infection in Lyme disease can evade the host immune system and more readily persist.
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 i increased. Other antidepressants may have a therapeutic range one has to achieve at least a certain dosage .
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Quantity Of Research Available
A total of 211 citations were identified in the literature search. Following screening of titles and abstracts, 152 citations were excluded and 59 potentially relevant reports from the electronic search were retrieved for full-text review. Two potentially relevant publications were retrieved from the grey literature search for full text review. Of these potentially relevant articles, 55 publications were excluded for various reasons, and six publications met the inclusion criteria and were included in this report. These comprised one systematic review, one non-randomized study, and four evidence-based guidelines., presents the PRISMA flowchart of the study selection. Additional references of potential interest are provided in .