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Dr Horowitz Lyme Disease Treatment Protocol


Antimicrobial Treatments For Lyme Disease

#37: Dr Jill Interviews Dr Richard Horowitz on Lyme Disease Treatment

The conventional medical approach to Lyme disease treatment in adults is a ten to 21-day course of the antibiotic doxycycline.1 However, a growing body of research shows that this treatment is insufficient, if not completely ineffective, for cases of chronic Lyme disease. Functional medicine offers a far more comprehensive approach to the antimicrobial treatment of Lyme disease. Read on to learn about the types of antimicrobial treatment options available, and how they can be combined for optimal effect.

Specific Lyme Disease Protocol

This protocol will flush toxins and alleviate the bodys toxic load, replenish nutrition and ensure your body can absorb and assimilate nutrients, strengthen the immune system, and kill pathogens that cause us harm. It will work to rid the body of any infection, including viruses, but the protocol does emphasis effectiveness against difficult bacterial infection, molds and fungal infections, and parasites.

This means that this protocol will be extremely effective against bacterial infections such as syphilis, chlamydia, gonorrhea, and any ailments caused by fungal infections as well.

If a known viral co-infection exists, this protocol is strong enough to eliminate viruses, but you could do so faster by adding St. Johns Wort, Pau dArco, colloidal silver, zinc, olive leaf extract, and systemic enzymes. Personally, if it were me, I would just up the systemic enzyme dosage with the following protocol to combat viruses.

Prolonged Lyme Disease Treatment: Enough Is Enough

  • Lorraine Johnson, JD, MBA

Dr. Halperin’s editorial accompanies publication of the long-awaited NIH- sponsored randomized controlled trial by Fallon et al. from Columbia University. The Columbia study concludes that patients with chronic neurologic symptoms of Lyme disease benefit from longer therapy with intravenous antibiotics, despite the fact that these patients had been sick for an average of nine years and had failed prior treatment. Halperin disagrees with the study conclusion.

The Columbia study found improvement after 10 weeks of retreatment, but relapse when treatment was withdrawn. This clinical pattern has been reported for years in Lyme disease patients, consistent with persistent infection with the Lyme spirochete. . The Columbia study confirms that the quality of life in chronic Lyme disease is worse than in congestive heart failure. For these patients the math is simple: without treatment, there can be no improvement in quality of life. In treatment terms, not enough is not enough.


3. Johnson L, Stricker RB. Treatment of Lyme disease: A medicolegal assessment. Expert Rev Anti-Infect Ther 2004 2:533-557.

4. Phillips SE, Harris NS, Horowitz R, Johnson L, Stricker RB. Lyme disease: scratching the surface. Lancet 2005 366:1771.

5. Stricker RB. Counterpoint: Long-term antibiotic therapy improves persistent symptoms associated with Lyme disease. Clin Infect Dis 2007 45:149-157.

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What You Need To Know About Borrelia

Borrelia is an ancient microbe dating back 15-20 million years, and possibly even longer. Its an extremely adaptable microbe that can infect most anything with blood today, it commonly infects mammals, birds, and even some reptiles.

Infection is imperative for Borrelias survival. To complete its life cycle, it must infect a new host via a tick-bite, reproduce within that host , and then reboard a new tick when the host is bitten again.

That last step reboarding a new tick is crucial. If the host is never bitten by another tick, the microbe reaches a dead end. It cant spread to new hosts. Here are some either key facts you should know about Borrelia:

Limitations And Issues To Be Considered

Dr. Richard Horowitz, M.D.

Symptoms in early and late Lyme are similar,19 although long-term infection can result in advanced disease involving the heart, nervous system, or joints.19 Recent scientific evidence has demonstrated that Borrelia is able to persist after standard courses of antibiotics.8285 One potential way to use the HMQ early and later in the disease process where antibody testing may be negative is to identify individuals with a high HMQ score and multisystemic illness and evaluate them with a broad tick-borne testing panel ,86 including using recently identified inflammatory chemokines characteristic of those with an acute and later stage Borrelia infection.32,87

The larger question remains: How do you reliably identify Lyme sufferers from healthy individuals? what is healthy? is it someone who has never been exposed to the Bb bacteria? and is it someone who has been exposed, but has received appropriate treatment and now is symptom free? The results of the present study demonstrated that the HMQ score can discriminate between individuals with documented Lyme and healthy individuals. Additional research is needed to determine whether high HMQ scores can distinguish between those with Lyme disease and those who are sick from other illnesses.

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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.

Recommendations For Revision Of The Scale

Based on the results presented here, we suggest several revisions that could improve the HMQ. First, we recommend that the number of items be reduced based on the factor analysis. This would create an easily administered, shortened version for prescreening. A shortened version would be beneficial because of the predominance of cognitive dysfunction among individuals with Lyme disease whose cognitive impairments make focusing, attention, and reading particularly difficult. The concentration required to respond to the 38-symptom checklist may not be practical. If practitioners felt it necessary, they could follow up with the longer version as a diagnostic tool.

One suggestion for pruning the scale may be to remove items with high levels of not applicable responses. These items may be useful for practitioners doing general health screenings but may not be particularly useful in a prescreening tool for Lyme disease. Consideration should be given as to whether these items should be dropped or remain on the scale. For a short screening tool, our recommendation is to drop them. For a long-form version of the scale, our recommendation is to keep them but remove them from the calculation of the HMQ score.

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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.

Cognitive Symptoms Of Chronic Lyme Disease

Expert in Lyme Disease Dr. Richard Horowitz Discusses Autoimmunity – Redefining Medicine
  • Difficulty concentrating and staying focused
  • Memory problems
  • Confusion
  • Trouble forming words and thoughts

Its important to note that you do not have to experience every symptom to have chronic Lyme disease. You may only experience one symptom that is severe or multiple symptoms that are moderately painful.

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Warning: Dapsone Is A Harsh Drug

Dapsone in Lyme is a hard medicine to take. In fact, in my Seattle practice I see 30 percent of patients do not tolerate this medicine and have to stop taking it. At the November 2017 International Lyme and Associated Diseases conference in Boston, Richard Horowitz MD, the pioneer of the dapsone approach, spoke of similar findings in his practice during his conference presentation.

  • Check G6PD Levels Before You Start. Do not use dapsone if you have low Glucose-6-phosphate dehydrogenase deficiency. This condition mostly affects men. If a person has G6PD deficiency and they take dapsone, it could cause hemolysis . Before starting this medication, your physician should measure a G6PD blood test.
  • Dapsone Blocks Folate Metabolism. Dapsone works by blocking folate metabolism in germs, but it also blocks folate metabolism in red blood cells leading to severe anemia. To prevent this consider taking up to 65 mg of folate a day while you are on this medication at a 100 mg dose. If you use the newer 200 mg dose, you may need to take up to 120 mg of folate a day.
  • Dapsone Suppresses the Bone Marrow. Red blood cells are manufactured in the bone marrow. Dapsone makes it harder for the bone marrow to make red blood cells. Although this is a separate method from folate metabolism interference, it also can lead to anemia. If anemia is a problem, lowering the dapsone dose can help.
  • Because of these problems, dapsone in Lyme is not suitable for everyone.

    Herbal Lyme And Bartonella Persister Options*

    At the beginning of treatment, or after one to two months of treatment after a person is no longer having herxheimer reactions from their growing Lyme and/or Bartonella regimen, I am adding one or two of the following herbs. I usually start with the oil and/or the cryptolepis. Another option if you cannot take one of these is to substitute it for Japanese knotweed.

    What to Use for Growing Bartonella or Lyme

    Growing Lyme and Bartonella regimens could include cats claw, otoba, sida acuta, Japanese knotweed and/or houttuynia tinctures, cefuroxime, clarithromycin, azithromycin, grapefruit seed extract, tinidazole, rifampin, bactrim or metronidazole. See A Lyme Disease Antibiotic Guide and/or Kills Bartonella: A Brief Guide for more information specific to the germ you are trying to kill.

    What to Use for Persister Bartonella or Lyme*

    • Liposomal Cinnamon Clove & Oregano Oil. Take one pill two times a day. This is my go-to herbal option. I prefer the Doctor Inspired Formulations product called Liposomal Cinnamon Clove & Oregano Essentials. I include it in most of my Lyme and Bartonella treatments.
    • Cryptolepis Tincture. Work up to 5 ml 3 times a day over three weeks by starting at 5 ml 1 time a day, then 5 ml 2 times a day, then 5 ml 3 times a day.
    • Japanese Knotweed. Work up to 1.25 ml to 2.5 ml 3 times a day over a 3 week period of time.

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    Ilads Member Richard Horowitz Publishes New Article In The Journal Antibiotics On Double Dose Dapsone Combination Therapy For Cld/ptlds

    ILADS member Richard Horowitz published a new article titled Efficacy of Double-Dose Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome and Associated Co-infections: A Report of Three Cases and Retrospective Chart Review in the journal Antibiotics.


    Three patients with multi-year histories of relapsing and remitting Lyme disease and associated co-infections despite extended antibiotic therapy were each given double-dose dapsone combination therapy for a total of 78 weeks. At the completion of therapy, all three patients major Lyme symptoms remained in remission for a period of 2530 months. A retrospective chart review of 37 additional patients undergoing DDD CT therapy was also performed, which demonstrated tick-borne symptom improvements in 98% of patients, with 45% remaining in remission for 1 year or longer. In conclusion, double-dose dapsone therapy could represent a novel and effective anti-infective strategy in chronic Lyme disease/ post-treatment Lyme disease syndrome , especially in those individuals who have failed regular dose dapsone combination therapy or standard antibiotic protocols. A randomized, blinded, placebo-controlled trial is warranted to evaluate the efficacy of DDD CT in those individuals with chronic Lyme disease/PTLDS.

    Ways To Prevent And/or Treat Covid Per Horowitz And Others

    Take Dr. Horowitz

    by Mary Beth Pfeiffer, thefirstepidemic.com

    Becoming infected with COVID-19 even after exposure to it is not inevitable.

    The virus is a bear, yes. But, if masks and distancing fail, it may be vanquished using safe, over-the-counter supplements for which there are supporting studies. The substances, used everyday by thousands, may even heal.

    The evidence for this is still speculative since no clinical trials have been done. We need those studies now. But there is a wealth of medical literature to suggest that we can take some control over our fate with a simple visit to a health food store.

    Im writing this article lest it read like an ad for Vitamins-R-Us for 10 selfish reasons: My two grown children, their spouses and five children, and their dad my husband. Ten people I love. Among the group are students, a teacher and a school administrator.

    I fear school reopening. I want to protect my family.

    So I contacted Dr. Richard Horowitz, a renowned Lyme disease physician who in April published the first study of two COVID patients treated with three natural supplements they were also given the antimalarial drug hydroxychloroquine and an antibiotic. At 9 and 11 days into treatment, with both patients seeing gradual but incomplete improvement, a corner turned.

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    Candida And Fungal Infections

    Candida syndrome with intestinal dysbiosis is not an uncommon health problem. It should be suspected in any MSIDS patient who has unexplained fatigue, joint and muscle pain, and neurological symptoms such as brain fog and headaches that are unresponsive or worsen with standard treatment regimens.

    I first learned about candida many years ago after one of my patients had developed a strange set of skin rashes that worsened every time she took antibiotics. She also complained of chronic fatigue, headaches, blood sugar swings, trouble concentrating, and digestive problems. In searching for answers, I came across William Crooks book, The Yeast Connection. In it he described my patients symptoms perfectly. By placing her on a yeast-free diet and treating the candida with antifungal agents, we were able to reverse all of her symptoms, which had baffled dermatologists and other subspecialists who had been unable to find a cause.

    Although we normally have candida organisms present in our gastrointestinal tract in limited amounts, taking antibiotics for bacterial infections will encourage an overgrowth of candida.

    Antibiotics kill off the good bacteria that keep our normal level of yeast in check. Furthermore, the standard American diet, which is high in sugar and refined carbohydrates, can promote an overgrowth of yeast. Other factors that may contribute to the candida syndrome are:

    Treating Candida and Yeast Infections

    Glutathione Plays A Crucial Role In Severe Covid Illness

    Studies published in ACS Infectious Disease8 and Antioxidants9 proposed that glutathione plays a crucial role in the bodys fight against the severe inflammatory response triggered by the SARS-CoV-2 virus. The research group in the ACS Infectious Disease study called it the most likely cause of serious manifestations and deaths in COVID-19 patients.

    In that study,10 they theorized the higher infection rate in older individuals and those with comorbidities suggest these groups are sensitive to environmental factors. Certain medical conditions have been identified that increase the risk of severe illness from COVID-19. These include chronic lung disease, Type 2 diabetes, heart conditions, obesity and smoking.11

    Specifically, the researchers12 homed in on an impaired redox homeostasis and concurrent oxidative stress in individuals of advanced age and with comorbidities. Redox homeostasis is a process that helps ensure a proper cellular response to stimuli.

    When this is dysregulated, oxidative stress can lead to cell death and contribute to disease development.13 Glutathione plays a crucial role in the inflammatory response, which the researchers theorize is a feasible means in the treatment and prevention of COVID-19. They wrote:14

    The hypothesis that glutathione deficiency is the most plausible explanation for serious manifestation and death in COVID-19 patients was proposed on the basis of an exhaustive literature analysis and observations.

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    Antimicrobials That Kill Growing Phase Spirochetes



    • 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


    • 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


    • 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