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.
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.
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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What Did It Find
- Compared to doxycycline, there was no difference between the following antibiotics for treatment response by 12 months: penicillin V , azithromycin , cefuroxime axetil , amoxicillin or ceftriaxone plus doxycycline .
- More than 80% of patients showed a treatment response, 84% at two or fewer months after starting treatment and 80% at 12 or more months following treatment initiation. There was no available data on outcomes for around 15%.
- There were few treatment failures in those people who were followed up 4% by two months and 2% by 12 months.
- Treatment-related adverse effects occurred in around 31% of people and included vomiting and diarrhoea as well as a Herxheimer-like reaction . Only 1% experienced haematologic adverse events, such as low platelet counts.
What You Should Know About Blacklegged Tick Bites
When it comes to Lyme and other tick-borne illness, prevention is the best form of medicine. When spending time in areas where ticks may be present, wear long sleeves and pants, tuck your pants into your socks, and wear tick repellent containing DEET, picaridin, IR3535, or oil of lemon eucalyptus. Pretreat outdoor clothing and gear with permethrin, an insecticide that kills ticks on contact. Clothing can be treated at home with sprays or dips that are effective for 2-6 weeks . Always check yourself for ticks after each potential exposure check pets, even those treated with tick repellents, after every trip outside. For more on tick bite prevention, see our Lyme brochure.
If you are bitten by a tick, here is information you should have.
The information below is for educational purposes only. It is not intended to replace or supersede patient care by a healthcare provider. If you suspect the presence of a tick-borne illness, you should consult a healthcare provider who is familiar with the diagnosis and treatment of tick-borne diseases.
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What Treatment Approach Did Well Patients And High Responders Use
We asked patients what their treatment approach was and listed four options a) antibiotics, b) alternative treatments, c) both antibiotics and alternative treatments, and d) no treatment at all. High treatment response was most closely associated with the use of antibiotics compared to patients who were using alternative treatments alone or forgoing treatment altogether. Treatment with antibiotics for Lyme disease was far higher among well patients and high responders compared to non-responders .
As you can see in the chart below, many patients who were taking antibiotics were also taking herbal supplements, which can be antimicrobial . So it is possible that there was a synergistic effect between antibiotics and herbal supplements.
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.
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Questions To Ask Your Veterinarian
If your dog has a positive Lyme test but no symptoms of the disease or protein in the urine, ask your veterinarian why he or she is recommending treatment. Experts currently recommend against antibiotic therapy under these circumstances because the dogs immune system is holding the bacteria in check and antibiotics are unable to eliminate the infection.
Dogs who have contracted Lyme disease do not develop prolonged, protective immunity and can be reinfected at a later date. Talk to your veterinarian about how best to prevent future infections. Options include measures to prevent the ticks that carry Lyme disease from biting your dog and Lyme vaccination.
What Causes Lyme Disease
People get Lyme disease when they are bitten by an infected tick. Ticks live in areas with a lot of plant life, such as wooded areas or fields. They sit near the top of grassy plants and low bushes. They wait there for people or animals to brush up against them. Ticks can crawl on your clothes or body for up to several hours or more before attaching to the skin.
Ticks can attach to any part of your body. They are usually found in hard-to-see areas, including the armpits, groin, or scalp. An infected tick needs to be attached to your skin for 36 to 48 hours before it passes the bacteria on to you.
People who spend time in outdoor areas where ticks are common are at higher risk of getting tick-borne diseases.
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A Targeted Lyme Disease Treatment
But back to the optimism mentioned at the start of this article: During a recent study, a team under Kim Lewis at Northeastern University found that a compound called hygromycin A is completely harmless to animals and has little effect on most bacteria except so-called spirochete bacteria, named for their spiral shape. For those, it is deadly. And Borrelia burgdorferi, the pathogen that causes Lyme disease, belongs to just this group.
Hygromycin A is an antimicrobial agent found in soil. The substance was originally discovered in 1953. At the time, however, scientists dismissed it as ineffective, probably because it seemed too weak to fight normal pathogens. But Lewis considers it exceptionally effective against spirochetes.
Lewis’ team discovered the efficacy of hygromycin A while screening microorganisms in soil for antimicrobial compounds. “We set out to find such a compound that would selectively kill Borreliella burgdorferi , placing a bet, if you will, that Mother Nature had bothered to evolve a compound to selectively take out spirochetes that live in the soils,” Lewis says.
And indeed, Mother Nature has done exactly that.
The researchers have already licensed the compound to Flightpath, a biotech company specializing in Lyme disease, to conduct development studies and advance production of this treatment.
What Is The Treatment For Lyme Disease
The first-line standard of care treatment for adults with Lyme disease is doxycycline, a tetracycline antibiotic. Other antibiotics that have activity against borrelia include the penicillin-like antibiotic, amoxicillin, and the second generation cephalosporin, Ceftin. The mainstay of treatment is with oral antibiotics, but intravenous antibiotics are sometimes indicated for more difficult to treat cases of neurologic-Lyme disease, such as meningitis, and cases of late Lyme arthritis.
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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 “proof” their nests. The nicotine wards off parasites, but sadly the neurotoxin can also have negative effects on the chicks.
Ticks – a plague for humans and animals alike
Macrolide Plus Azole Plus Liposomal Essential Oils
- clarithromycin 500 mg 1 pill 2 times a day
- tinidazole 500 mg 1 pill 2 or 3 times a day.
- liposomal cinnamon, clove & oregano oil 1 capsule 2 times a day
Key Points
- Tinidazole treats cysts and can remove biofilms that block the immune system and antibiotics.
- Liposomal cinnamon, clove & oregano oil can treat persister and growing forms of Lyme. Of the various herbal options to treat persiters – this is my go to persister herbal anti-microbial based on benefits I see in my practice.
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Azlocillin Comes Out On Top
The drug, which is not on the market, was tested in mouse models of Lyme disease at seven-day, 14-day and 21-day intervals and found to eliminate the infection. For the first time, azlocillin was also shown to be effective in killing drug-tolerant forms of B. burgdorferi in lab dishes, indicating that it may work as a therapy for lingering symptoms of Lyme disease.
Pothineni and Rajadas have patented the compound for the treatment of Lyme disease and are working with a company to develop an oral form of the drug. Researchers plan to conduct a clinical trial.
Rajadas is also a professor of bioengineering and therapeutic sciences at the University of California-San Francisco.
Other Stanford co-authors are Hari-Hara S. K. Potula, PhD, senior research scientist postdoctoral scholars Aditya Ambati, PhD, and Venkata Mallajosyula, PhD senior research scientist Mohammed Inayathullah, PhD and intern Mohamed Sohail Ahmed.
A researcher at Loyola College in India also contributed to the work.
The study was funded by the Bay Area Lyme Foundation and Laurel STEM Fund.
- Tracie White
Stage : Early Disseminated Lyme Disease
Early disseminated Lyme disease occurs several weeks to months after the tick bite.
Youll have a general feeling of being unwell, and a rash may appear in areas other than the tick bite.
This stage of the disease is primarily characterized by evidence of systemic infection, which means infection has spread throughout the body, including to other organs.
Symptoms can include:
- disturbances in heart rhythm, which can be caused by Lyme carditis
- neurologic conditions, such as numbness, tingling, facial and cranial nerve palsies, and meningitis
The symptoms of stages 1 and 2 can overlap.
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Tetracycline Plus Macrolide Plus Grapefruit Seed Extract Plus Japanese Knotweed
- doxycycline 100 mg 2 pills 2 times a day
- clarithromycin 500 mg 1 pill 2 times a day
- grapefruit seed extract 250 mg 1 pill 2 times a day.
- Japanese knotweed½ tsp 3 times a day
Key Points:
- Tetracyclines and macrolides both block protein production by binding to the protein production apparatus in germs called ribosomes. But they each bind to a different part of the ribosome improving the blockade of protein production.
- Japanese knotweed is added here to treat persister Lyme. It also may treat growing Lyme and can lower inflammation cytokines.
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.
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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.
A Selective Antibiotic For Lyme Disease
- 7 These authors contributed equallyNadja Leimer7 These authors contributed equallyAffiliations
- 7 These authors contributed equallyXiaoqian Wu7 These authors contributed equallyAffiliations
- 7 These authors contributed equallyYu Imai7 These authors contributed equallyAffiliations
- Diane G. EdmondsonAffiliationsDepartment of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77225, USA
- Steven J. NorrisAffiliationsDepartment of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 77225, USA
- 7 These authors contributed equally8 Lead contact
- A selective screen against B. burgdorferi led to the rediscovery of hygromycin A
- The mechanism of selectivity is puzzling because hygromycin A targets the ribosome
- Hygromycin A is smuggled into spirochetes by the conserved transporter BmpDEFG
- Hygromycin A is efficacious in a mouse model without disturbing the microbiome
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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.
Has Niaid Looked At The Potential Benefits Of Long
Yes. NIAID has funded three placebo-controlled clinical trials on the efficacy of prolonged antibiotic therapy for treating PTLDS. The published results were subjected to rigorous statistical, editorial, and scientific peer review.
These trials were designed to ensure that several key parameters were addressed:
- The susceptibility of B.burgdorferi to the antibiotics used
- The ability of the antibiotics to both cross the blood-brain barrier and access the central nervous system and to persist at effective levels throughout the course of therapy
- The ability of the antibiotics to kill bacteria living both outside and inside mammalian cells
- The safety and welfare of patients enrolled in the trials
The first clinical trial, which included two multicenter studies, provided no evidence that extended antibiotic treatment is beneficial. In those studies, physicians examined long-term antibiotic therapy in patients with a well-documented history of previous Lyme disease but who reported persistent pain, fatigue, impaired cognitive function, or unexplained numbness. Those symptoms are common among people reporting PTLDS. Patients were treated with 30 days of an intravenous antibiotic followed by 60 days of an oral antibiotic.
In 2016, a clinical trial conducted in the Netherlands also concluded that in patients with persistent symptoms attributed to Lyme disease, longer term treatment with antibiotics did not provide additional benefits compared with shorter term regimens.
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