Use these same prescriptions with children but at lower doses. Studies of the effects of antibiotic therapy in animals infected withB. burgdorferihave been conducted most often with mice but also with rats,hamsters, gerbils, dogs, and non-human primates. Cefuroxime should be taken with food in twice daily dosing. Mindfulness meditation and Yoga can reduce stress and pain and enhance energy. Patients with depression often experience problems with memory and verbal fluency; when the depression is resolved, the memory and verbal fluency typically resolve as well. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 5 Effective Therapies to Consider for Chronic Lyme Disease. Most recently, a clinical trial out of the Netherlands concluded that in patients with persistent symptoms attributed to Lyme disease, longer term treatment with antibiotics did not provide additional benefits compared with traditional treatment regimens. Liposomal cinnamon, clove, and oregano oil can treat persister and growing forms of Lyme. Rule 2: Combine antibiotics to treat Lyme living outside and inside of cells. 2008;5:40. doi:10.1186/1742-2094-5-40(, Pothineni VR, Wagh D, Babar MM, et al. Quinine derivatives, like hydroxychloroquine (Plaquenil), can make the inside of cells more basic (less acidic), which can help the tetracyclines and macrolides mentioned above work better. To help justify these various antimicrobial options, in this section I describe the experimental basis behind my recommendations. Evaluation of disulfiram drug combinations and identification of other more effective combinations against stationary phase Borrelia burgdorferi. However, this medicine will not work for colds, flu, or other virus infections. Raven Press; 2015. The tablet may be taken with or without food. Note: In most individuals Bicillin is self-administered, often in the muscle of the buttocks. Here we simply wish to provide some important facts that people should know about various treatments. Before I describe herbal and prescription antibiotic approaches I find helpful treating Lyme in my Seattle practice, lets talk about terms. The other option I offer is a disulfiram-only regimen or a disulfiram-combination regimen. Following antibiotic therapy, approximately 90% of late Lyme arthritis patients recover from extensive joint swelling, arthritis, and pain. Furthermore, while herbal antibiotics may work inside of cells, it is not clear from research that they do. These studies reinforced the evidence that patients reporting PTLDS symptoms have a severe impairment in overall physical health and quality of life. doi:10.1586/14787210.2014.940900(, Datar A, Kaur N, Patel S, Luecke DF, Sapi E. In Vitro Effectiveness of Samento and Banderol Herbal Extracts on the Different Morphological Forms of Borrelia Burgdorferi. It was not possible to culture these bacteria and it is not clear whether they are infectious. All the antibiotics mentioned in this article may be pulse-dosed except for azithromycin. Some patients report persistent symptoms of pain, fatigue, or difficulty thinking even after treatment for Lyme disease. Some are on the six-month program, while others may require years. For more information on this read Disulfiram. Applies to the following strengths: 25 mg/mL; 750 mg/150 mL; 250 mg/50 mL; 500 mg/100 mL; 250 mg; 500 mg; 750 mg Usual Adult Dose for: Nosocomial Pneumonia Pneumonia Skin and Structure Infection Prostatitis Inhalation Bacillus anthracis Cutaneous Bacillus anthracis (See. Research first published in 2015 shows that Lyme has two different growth states. Therefore, rigorous diagnostic evaluation is necessary to determine if Lyme disease could be the trigger for ongoing disease processes or if some other disease processes are involved. Both regimens have some published clinical evidence of benefit. Disulfiram has good bioavailability and passes through the blood-brain barrier, treating neuroborreliosis. Because of this, I only use disulfiram alone to treat Lyme when these other germs are not active. You can read more details about how to take both regimens in: In my experience, I find the prescription antibiotic combinations below work 85-90 percent of the time. However, I have seen wonderful recoveries for many on herbal antibiotics, so I assume the ones I recommend in this article help with intracellular Lyme. Methylene blue is repurposed to treat Lyme and Bartonella. In one study, NIAID-supported scientists found that remnants ofB. burgdorferiremained in mice after antibiotic treatment. The drugs were different in their pharmacological class, chemical structure, and mechanism of action to identify effective compounds. In 2022, our Center began its first two treatment trials for patients with Lyme disease infection associated chronic illness. Based on his reports and based on my experience, this repurposed drug is effective at putting about 36 percent of people with Lyme into remission and may help a larger group to have symptom improvements. Established name: cefdinir . Patients often call this condition chronic Lyme disease, although an agreed upon clinical case definition for chronic Lyme disease has proven difficult to reach a consensus on. I use this one most commonly because it is the easiest to administer and one of the lowest cost IV regimens. Dr. Liegners research shows that when disulfiram is used as a solo antibiotic, 36 percent of people can enter a period of extended remission. Therefore, the plan that follows is notand cannot bea complete or comprehensive guide. One way to pulse is in a 4-day-on-and-3-day-off cycle. At the beginning of treatment for someone with chronic Lyme, it is difficult to predict what the length and degree of recovery will be. The published results were subjected to rigorous statistical, editorial, and scientific peer review. It also may treat growing Lyme and can lower inflammation cytokines. Previously its use was discouraged in children under age 8, but the American Academy of Pediatrics has recently revised their guidelines to allow use. BMC Microbiol. None of these treatments have been FDA-approved for the treatment of Lyme disease-related symptoms. In two different studies in 2021, however, Dr. Zhang and colleagues have shown Cryptolepsis is effective at treating growing and persister forms of Bartonella and Lyme. Daptomycin is an intravenous antibiotic and had the highest activity against the persister phase of Borrelia but was not effective against the growth phase. Persisting atypical and cystic forms of Borrelia burgdorferi and local inflammation in Lyme neuroborreliosis. Identification of additional anti-persister activity against Borrelia burgdorferi from an FDA drug library. Cefdinir is stable in the presence of some, but not all, -lactamase enzymes. Vancomycin, imipenem, and ertapenem (Ivanz) are possible alternatives if someone is allergic to ceftriaxone or cefotaxime. They can happen within hours to weeks after starting this medicine (levofloxacin tablets). Based on Horowitz experiments and my use of the medication with my patients, I find improvements of 20 percent or so in those that can tolerate the treatment. Cefuroxime works by disrupting cell wall synthesis and does cross the blood brain barrier to some extent. As an alternative, ceftriaxone could be given daily as 2 gm IV 1 time a day. The pattern of infection is dependent upon the strain of. The essential oils are added to treat persister Lyme. Unfortunately, nitroxoline and furazolidone are not available in the United States, but the combination of cefuroxime + nitazoxanide + clarithromycin is readily available. Drug Des Devel Ther. Most studies have found plain amoxicillin to be highly effective against Borrelia burgdorferi and thus the combination (Augmentin) is not needed. Borrelia burgdorferi, the bacteria that causes Lyme disease, is a corkscrew-shaped spirochete that propels its way through blood and burrows into tissues. The 165 hits were narrowed to the top 27 drug candidates against stationary phase Borrelia. In a small number of the treated mice, however, bacteria were detected in their tissues. Doctors are taught in medical school: "Above all do no harm". It belongs to the class of medicines known as cephalosporin antibiotics. To reach the success rates I describe here, it is essential to follow the first 10 steps of The Ross Lyme Support Protocol to support the immune system. This staining seems not to be an issue if they are used for a month or less. 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. Gaps in knowledge can lead to problems in clinical care. The longer the bacteria are cultured, the more significant number of bacteria morph into the persister phase. Johns Hopkins Lyme Disease Research Center. They appear to kill intracellular and extracellular Lyme, too, based on the clinical benefit I see in my medical practice. Patients received either 10 weeks of intravenous ceftriaxone or intravenous placebo, and were examined for clinical improvement using objective memory tests. For more information, please see theChronic Lyme Diseasesection. The Buhner/Rawls combination helps about 60-65 percent of the time in my clinical observations. Early diagnosis and proper antibiotic treatment of Lyme disease is important and can help prevent late Lyme disease. Individuals with neurologic Lyme disease, cardiac Lyme disease, or Lyme arthritis that hasnt responded well to oral antibiotic treatment will often be given intravenous ceftriaxone. The lower the MIC, the more effective the medication kills the bacteria. It is essential to your recovery that, at a minimum, your treatment addresses the steps outlined in my Lyme disease treatment guidelines, The Ross Lyme Support Protocol (Chapter 4). Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website. This happens to all of us when we hear someone's name at a party; if we don't focus on the name and perhaps make a mental association to the name to enhance memory storage, we will forget that name within minutes. As with other cephalosporins, bactericidal activity of cefdinir results from inhibition of cell wall synthesis. Effect of different drugs and drug combinations on killing stationary phase and biofilms recovered cells of Bartonella henselae in vitro. See full profile:onLinkedIn In Europe, doxycycline is considered to have comparable efficacy for neurologic Lyme disease as intravenous ceftriaxone; this has not yet been examined in the United States however and may not apply to U.S. neurologic Lyme disease as the genospecies causing neurologic Lyme in the US is B.burgdorferi while in Europe it is most commonly caused by B.garinii. In the clinical context there is an ongoing debate about renaming chronic Lyme disease to another name such as Long-haul Lyme, persistent Lyme disease, or Lyme disease associated chronic illness. Evaluation of in-vitro antibiotic susceptibility of different morphological forms of Borrelia burgdorferi. 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. Evaluation of natural and botanical medicines for activity against growing and non-growing forms of B. burgdorferi. 2019;8(2):50. doi:10.3390/antibiotics8020050(, Liegner KB. Risk factors for Post Treatment Lyme Disease include: Increased severity of initial illness, the presence of neurologic symptoms, and initial misdiagnosis increase the risk of Post Treatment Lyme Disease. Doxycycline, amoxicillin, azithromycin, clarithromycin, and penicillin G (Bicillin) had poor activity against Borrelia persisters. doi:10.1177/2049936116655502(, Horowitz R, Freeman, PR. Though the procedure becomes fairly simple with the availability of HTS (high-throughput screening) methods and large collections of drug libraries, the development of drugs against slow-growing organisms still remains an uphill task. The drug provides good coverage against Haemophilus influenzae, Moraxella catarrhalis and penicillin-susceptible Streptococcus pneumoniae, the most common respiratory tract pathogens. The disulfiram is added here to treat persister Lyme. If you have learned that chronic Lyme disease is the underlying cause of your symptoms, the next hurdle is finding effective treatments. In 2020, the paper Evaluation of Disulfiram Drug Combinations and Identification of Other More Effective Combinations against Stationary Phase Borrelia burgdorferi was published. Ceftriaxone is a third generation cephalosporin and, like other cephalosporins, is bacteriocidal. 2016;10:13071322. In more complicated cases, Lyme disease can usually be successfully treated with three to four weeks of antibiotic therapy. Lyme disease is the most common and is endemic to the Mid-North Atlantic states and in areas of the Great Lakes. Antibiotics (Basel). Augmentin is a combination medication that includes both amoxicillin and the enzyme inhibitor clavulanate that allows the amoxicillin to be more effective against other penicillin-resistant microbes; a downside of this combination is that it might cause significantly more gastrointestinal disturbance than plain amoxicillin. Route of administration: ORAL (C38288) Active ingredients (moiety): cefdinir (cefdinir) This is a medicine that requires 3x daily dosing; it is important to maintain frequent dosing in order to keep the blood levels of the antibiotic high enough to be effective. Clinically, I see great benefit in using the rifamycins as my anti-cyst agents, so I list them here. In 2014, researchers from Johns Hopkins published the first study to assess the full spectrum of antibiotic susceptibility against persister phase Borrelia. Note: If you are allergic penicillin or to cephalosporins, then there is a good chance you may develop an allergic reaction to amoxicillin. But the risk of serious side effects is higher. It may be more effective than continuous regimens. It can be helpful to use probiotics to restore the good bacteria and microbiome balance. Disulfiram is shown in lab experiments by Jayakumar Rajadas, PhD and colleagues at Stanford to treat Lyme persisters. 2020;9(9):542. doi:10.3390/antibiotics9090542(. Infect Microb Dis. Our Center is investigating the potential roles of: Our research has validated PTLD as a serious and impairing condition. Azlocillin at relatively low concentrations eliminated stationary phase Borrelia. Research results can be extrapolated and generalized when appropriate to the much broader group of patients with chronic or persistent Lyme disease. Rule 3. Many physicians have different ways of pulsing antibiotics. Patients were treated with 30 days of an intravenous antibiotic followed by 60 days of treatment with an oral antibiotic. However, this medicine will not work for colds, flu, or other virus infections. Post Treatment Lyme Disease (PTLD) represents a research subset of patients who remain significantly ill 6 months or more following standard antibiotic therapy for Lyme disease. 2019;8(2):72. doi:10.3390/antibiotics8020072(, Ma X, Leone J, Schweig S, Zhang Y. Botanical medicines with activity against stationary phase Bartonella henselae. The study, titled Identification of novel activity against borrelia burgdorferi persisters using an FDA approved drug library, screened over 1500 medications and identified 165 that had better activity against stationary Borrelia than doxycycline and amoxicillin. Dr. Zhang and colleagues at Johns Hopkins University have shown methylene blue treats growing and persister states of Lyme. Researchers in the Lyme disease community were aware that the commonly prescribed antibiotics for Lyme disease were ineffective against chronic Lyme, so they set out to identify more effective treatments. Psychotherapy has many different types such as supportive, dynamic, cognitive behavioral, dialectical behavior therapy, transference focused psychotherapy each of which offers benefit. Continue treatment with antibiotics until you are well. As Lyme is a slow-growing germ, the spirochete form only requires two to three days for some antibiotics to work and then several days to recover and Lyme to start growing again. Most anti-depressants take three to eight weeks before an effect is seen. treats all growth phases of Lyme at the same time. Levofloxacin injection is indicated for inhalational anthrax (post-exposure) to reduce the incidence or progression of disease following exposure to aerosolized Bacillus anthracis. Cefdinir is used to treat bacterial infections in many different parts of the body. The goal is to restore one's health and functional status so as to maximize quality of life. Given that it is essential for efficacy that the drug be administered every 8 hours, cefotaxime is less commonly used than ceftriaxone. The two big ones out there are Cipro or Ciprofloxacin, and Levaquin or Levofloxacin. Pregnant women in particular should check with their physician; a good website to check for for drug interactions is "Mother to Baby". Amoxicillin can be taken with or without food. In a randomized, sham-controlled trial of acupuncture of 127 individuals diagnosed with "chronic fatigue syndrome" (two sessions per week for four weeks), the acupuncture group showed moderately large reductions in physical and mental fatigue. The ceftriaxone is given in a syringe and injected over 10 minutes. Musculoskeletal pain may be helped by low-dose naltrexone, as 2 published trials have reported benefit in fibromyalgia. However, I find herbal antibiotics work well for a year or more without changing the herbs. Antibiotics (Basel). In addition, adverse effects attributed to intravenous ceftriaxone occurred in 26 percent of patients. Subscribe to receive our FREE pdf download book: How to Successfully Treat Lyme: Key Info before You Treat or Treat Again & The Ross Lyme Support Protocol; health tips; updates; special offers; and more. Even a year or more into treatment, when a person is feeling better, these steps are essential to speed recovery by supporting the immune system. Neurofeedback may be helpful in improving pain, as well as in improving sleep and attention. Save my name, email, and website in this browser for the next time I comment. The three first-line oral antibiotics for Lyme disease include doxycycline (Monodox, Doryx, Vibramycin, Oracea), amoxicillin (Amoxil), and cefuroxime (Ceftin, Zinacef). However, disulfiram is a very difficult drug to use. Because of this, drug-drug interactions can occur. Note: disulfiram does not appear to treat Bartonella. Join our mailing list to receive the latest news and updates fromJohns Hopkins Rheumatology and the Johns Hopkins Lyme Disease Research Center. Outside of cells, Lyme infection has two different looks, or forms. The first-line standard of care treatment for adults with Lyme disease is doxycycline, a tetracycline antibiotic. The causes of PTLD are not yet well understood but can be multifactorial. Buhner SH. The antibiotics with the most significant activity against persister Borrelia bacteria were daptomycin, clofazimine, carbomycin, some cephalosporins, and some sulfa drugs. Combine antibiotics to treat all forms of the germ. Neuropathic, muscular, and arthritic pain can often be helped with agents such as amitriptyline, cyclobenzaprine, or SNRIs (e.g., duloxetine (Cymbalta), milnacipran (Savella), venlafaxine (Effexor)). Think of the persisters as germs that are in hibernation. There was a small open label trial that showed that gabapentin was quite helpful in reducing neuropathic pain for a group of Lyme patients complaining of persistent fatigue (Weissenbacher 2005). If you are interested in information on chronic Lyme diseaseexternal icon, see NIHs website. In my experience, I find most oral antibiotic combinations to work about 85 percent of the time, while IV equivalent treatments work about 90 percent of the time. However, the clinical name should not limit research into underlying causes and biomarkers for this persistent illness. In 2016, researchers from Stanford University used high-throughput screening to identify compounds that were effective against Lyme disease. Interestingly, the alcohol abuse medication disulfiram was effective against Borrelia. As an example, penicillins (like amoxicillin) and cephalosporins (like cefuroxime) only work outside of cells. Other antibiotics that have activity against borrelia include the penicillin-like antibiotic, amoxicillin, and the second generation cephalosporin, Ceftin. Improving sleep hygiene is the best approach for insomnia. NIAID, in collaboration with NINDS, supported comprehensive studies on non-human primates looking at the neuropathology associated with post-treatment Lyme disease syndrome. However, the prognosis worsens when diagnosis and treatment are delayed. In a 2008 study, mice were treated with the antibiotic ceftriaxone for one month following either early or later stages of infection withB. burgdorferi. OMNICEF and other antibacterial drugs, OMNICEF should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria. Amoxicillin/clavulanate (Augmentin) Augmentin is a combination antibiotic that contains amoxicillin and clavulanate. Second, it addressed previous criticisms of overly strict enrollment criteria for the other studies by broadening the diagnostic criteria required for enrollment. First, it addressed treatment for infection with the European Borrelia species B. garinii and B. afzelii. 2016;59(8):46164624. Experimentally, since stationary phase cultures contain mixed populations of growing and non-growing bacteria that have different morphological variants such as round bodies and microcolonies that are more tolerant to antibiotics, it is most likely that a single drug may not effectively kill all bacterial populations, including morphological variants.. The roles of immune dysfunction, autoimmunity, chronic inflammation, persistent bacterial infection, persistent bacterial antigenic debris, neural network alteration, and other potential causative biologic mechanisms of PTLD are being investigated at our Center.