Key Points For Healthcare Providers
Herbal And Rx Antimicrobials That Treat Persisters
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.
How Is Lyme Disease Treated
In its early stages, Lyme disease can be effectively treated with antibiotics. In general, the sooner such therapy is begun following infection, the quicker and more complete the recovery. Antibiotics, such as doxycycline or amoxicillin taken orally for two to four weeks, can speed the healing of the rash and can usually prevent subsequent symptoms such as arthritis or neurological problems. There is no compelling evidence that prolonged antibiotic therapy is more effective than two weeks of therapy. Prolonged antibiotic use may have serious side effects.
Intravenous antibiotics may be used for more serious cases and for someone whose nervous system has been affected. Lyme disease with arthritis also can be treated with antibiotics. Most patients experience full recovery.
Patients younger than 9 years or pregnant or lactating women with Lyme disease are treated with amoxicillin or penicillin because doxycycline can stain the permanent teeth developing in young children or unborn babies. Patients allergic to penicillin are given erythromycin or related antibiotics.
Doctors prefer to treat Lyme disease patients experiencing heart symptoms with antibiotics such as Rocephin, Claforan, or penicillin given intravenously for about two weeks. If these symptoms persist or are severe enough, patients may also be treated with corticosteroids or given a temporary internal cardiac pacemaker. People with Lyme disease rarely experience long-term heart damage.
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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.
What Are The Symptoms Of Lyme Disease
In the early stages of Lyme disease, you may experience flu-like symptoms that can include a stiff neck, chills, fever, swollen lymph nodes, headaches, fatigue, muscle aches, and joint pain. You also may experience a large, expanding skin rash around the area of the tick bite. In more advanced disease, nerve problems and arthritis, especially in the knees, may occur.
Here are some more details:
Lyme disease imitates a variety of illnesses and its severity can vary from person to person. If you have been bitten by a tick and live in an area known to have Lyme disease, see your doctor right away so that a proper diagnose can be made and treatment started
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How Is Lyme Disease Transmitted
Lyme disease is transmitted through a bite from a specific type of tick. The animals that most often carry these insects are white-footed field mice, deer, racoons, opossums, skunks, weasels, foxes, shrews, moles, chipmunks, squirrels, and horses. The majority of these ticks have been found in New York, Connecticut, Massachusetts, Maryland, New Jersey, Minnesota, and Wisconsin.
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.
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What Is Lyme Carditis
Lyme carditis occurs when Lyme disease bacteria enter the tissues of the heart. This can interfere with the normal movement of electrical signals from the hearts upper to lower chambers, a process that coordinates the beating of the heart. The result is something physicians call heart block, which can vary in degree and change rapidly. Lyme carditis occurs in approximately one out of every hundred Lyme disease cases reported to CDC.
The Truth About Antibiotic Treatments
Until recently, many doctors in Canada tended to prescribe only one round of antibiotics, irrespective of the stage of infection. However, current research suggests that a single course of antibiotics is often insufficient for treating Lyme disease, especially if the infection has been untreated for several months.
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Intravenous Antibiotics Injection For Lyme Disease Patients
Lyme disease is an infectious disease caused by the Borrelia bacterium which is spread by ticks. The most common sign of infection is an expanding area of redness on the skin, known as erythema migrants, that appears at the site of the tick bite about a week after it occurred.
In the early stages of Lyme disease, people treated with appropriate antibiotics usually recover rapidly and completely. Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime axetil. However, people with certain neurological or cardiac forms of the illness may require Intravenous Treatment with antibiotics such as ceftriaxone or penicillin.
The antibiotic is administeredthrough a small narrow flexible tube called a catheter or IV line, which isinserted into a vein using a needle. The needle is removed, and the IV line isleft in place and secured by a dressing. There are different types of IV linesavailable, and the one chosen for your treatment will depend on your veins andhow long you will need the antibiotics.
Typical IV therapy consists of a 2- to 4-week course. The patient undergoes a daily antibiotics injection which has been proven to be very effective. However, for some patients, it can be a bit long and discomforting process. A daily injection can represent a nightmare for those patients whose veins are hard to to detect.
Reference:
Type Of Clinician Overseeing Care
We asked patients to tell us the type of clinician overseeing their care. Choices included: family physicians, internists, rheumatologists, infectious disease specialists, and clinicians whose practice focused on tick-borne diseases . Very few patients selected an infectious disease specialist. Seventy-five percent of high responders and well patients report having their care overseen by an LLMD.
Physicians who treat Lyme disease as their primary focus might be expected to have better results than physicians who dont simply because volume of cases handled means a greater experience level. It is commonly recognized in medicine that volume of cases is associated with better treatment outcomes . Just as patients with cancer commonly seek out physicians who specialize in that area, perhaps patients with chronic Lyme disease should also.
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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.
Why This Is Important
The use and duration of antibiotics for chronic Lyme disease treatment is controversial because there is no biomarker that can determine whether the Lyme bacteria has been eradicated in CLD patients. Patients are often told that either chronic Lyme disease does not exist or that it is incurable. If this were true, we would not expect more well and substantially improved patients to be taking antibiotics. Instead, we might have expected the percentage of people using antibiotics to be roughly the same among the patient subgroups.
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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
What Factors Determine How Patients Respond To Treatment
To find out what made some patient substantially improve or become well, we turned to our academic partners at the University of California at Los Angeles who specialize in artificial intelligence and machine learning. Their team looked at 215 features related to diagnostic factors, treatment approach, duration of individual antibiotics, alternative treatments, symptoms, type of clinician, and functional impairment to identify the 30 top predictive features for treatment response . Most of the top 30 features identified in their study related to chronic Lyme disease treatment , symptom severity , and type of clinician treating Lyme disease. We analyzed three of these factors associated with treatment response:
- Treatment approach
- Treatment durations
- Type of clinician overseeing the patients care
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Antibiotic Treatment Of Lyme Carditis
Table 1. Mild
| Age Category | |||
|---|---|---|---|
| 100 mg, twice per day orally | N/A | ||
| 500 mg, three times per day orally | N/A | ||
| 500 mg, twice per day orally | N/A | ||
| 4.4 mg/kg per day orally, divided into 2 doses | 100 mg per dose | ||
| 50 mg/kg per day orally, divided into 3 doses | 500 mg per dose | ||
| 30 mg/kg per day orally, divided into 2 doses | 500 mg per dose | 14-21 | 3 |
Table 2. Severe *
| Age Category | |||
|---|---|---|---|
| 2 grams intravenously, once a day* | N/A | ||
| 5075 mg/kg intravenously, once a day* | 2 grams per day | 1421 | 3 5 12 |
*After resolution of symptoms and high-grade AV block, consider transitioning to oral antibiotics to complete treatment course .
Tissue sample from a patient who died of Lyme carditis. Image taken using Warthin-Starry stain at 158X.
The heart on the top shows how an electrical signal flows from the atrioventricular node to the chambers in the lower half of the heart, called the ventricles.
The heart on the bottom shows a case of third degree heart block. In this illustration, the electrical signal from the AV node to the ventricle is completely blocked. When this happens, the electrical signal of the atria does not transmit to the ventricles , which causes the ventricles to beat at their own, slower rate.
Picc Line For Lyme Disease:
PICC stands for peripherally inserted central catheter. Inserting a PICC line is a common procedure in which a thin, flexible tube will be inserted into a large vein in the upper arm. The tube will be threaded through the vein until it rests just above the heart. A technician will use a numbing agent so there is no pain and the tube will be guided through the vein with the help of ultrasound and/or X-ray. A PICC line can stay in place for several weeks or months without needing to be changed or taken out. It is a more effective way of delivering IV antibiotics into your body if you intend to be using them on a regular basis. The placement of the tube just above the heart allows for a quicker response time for medications and nutrients, etc. If done properly, once the line is in and the initial discomfort settles, it shouldnt be at all noticeable.
Each infusion with a PICC line will take anywhere from 30 minutes to an hour and a half and can be done at your own home either on your own or via a visiting nurse. Otherwise, infusions will be done at a hospital infusion lab or doctors office. PICC lines require regular cleaning by a nurse, either in home or at a facility.
This procedure should be taken seriously and adequate discussion and caution should be used when considering a PICC line with your doctor.
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Stages Of Lyme Disease
There are three stages of Lyme disease. Early localized Lyme disease is defined as being diagnosed soon after a tick has bitten you. You may have seen the tick, removed it, and noticed a rash. You may even be starting to feel like you have the flu or coping with headaches.
This is the best time to treat Lyme disease. This is, for many, the only stage in which oral antibiotics are successful. Once the disease begins to move to other places in the body, as it does in the Early Dissemination stage, oral antibiotics may not be strong enough to fight infection.
In the third stage, Late Lyme, it is unlikely oral antibiotics alone can rid you of the bacterial infection. This is when doctors and patients start to look at alternative methods of treatment.
Evaluation According To Protocol
Patients were required to have pretreatment serological testing, lumbar puncture, neuro-psychological testing, and brain MRI. The antibody response to B. burgdorferi in serum was determined by indirect ELISA and Western blotting , and positive results were interpreted according to the CDC/ASTPHLD criteria . Spinal fluid was tested for total cells and protein, and concomitant serum and CSF samples were tested for intrathecal IgM, IgG, and IgA antibody production to B. burgdorferi by antibody capture enzyme assay, as previously described . A response in CSF that was> 1 times that in serum was defined as local synthesis of specific antibody in CSF. B. burgdorferi DNA was detected in CSF by PCR by use of 2 different primer-probe sets that target different regions of the plasmid DNA encoding outer-surface protein A of the spirochete, as previously described .
Routine brain MRI, without gadolinium enhancement, was performed in all patients. After August 1992, it became possible to perform quantitative single photon emission computed tomography of the brain, newly reported in one study to be of use in evaluation of Lyme encephalopathy . SPECT was not available when the study began, and only the last 7 patients entered into the study underwent SPECT imaging.
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