When considering treatment options for Lyme disease, patients should find out how well studied these treatments are, whether they have been shown to be effective, and what the side effects are. In this type of situation, it is possible that the antibiotics have pushed most of the remaining germs out of a growing state into a persister state. Methylene Blue can treat persister Lyme. One regimen I offer is a Horowitz dapsone-persister regimen. Most anti-depressants take three to eight weeks before an effect is seen. In the absence of a direct diagnostic biomarker blood test, PTLD has been difficult to define by physicians, and its existence has been controversial. Any antibiotic can cause skin rashes, and if an itchy red rash develops while on antibiotics, a patient should see their physician. The medication should be kept refrigerated. It works successfully as a support in a Lyme treatment about 85-90 percent of the time. This is why most of the antibiotics prescribed to . Cefdinir (Omnicef) is an oral third-generation cephalosporin with good in vitro activity against many pathogens commonly causative in community-acquired infections. doi:10.2147/IDR.S19201(, Sharma B, Brown AV, Matluck NE, Hu LT, Lewis K. Borrelia burgdorferi, the causative agent of Lyme disease, forms drug-tolerant persister cells. Interestingly, the alcohol abuse medication disulfiram was effective against Borrelia. Refer to Finished? Overall, the study authors concluded that additional antibiotic therapy for PTLDS was not supported by the evidence. Generally, I suggest rotating a prescription antibiotic every six months to prevent resistance to that antibiotic. Historically, dapsone is used to treat Leprosy. S pneumoniae, Streptococcus viridans, Enterococcus faecalis: levofloxacin, moxifloxacin, trovafloxacin, gatifloxacin; Mycobacterium species: levofloxacin, moxifloxacin44 . It also may treat growing Lyme and can lower inflammation cytokines. Macrolides however should be used with caution given the risk of interaction with other medications. Antibiotics (Basel). Your clinician will need to order a glucose 6 phosphate dehydrogenase (G6PD) blood test. This is why most of the antibiotics prescribed to people who have had Lyme disease for months or years are ineffective. The following treatment regimens reflect CDCs interpretation of the most current data for four important manifestations of Lyme disease. Treating Borrelia, the Lyme germ, with antibiotics is complicated because limited research shows which treatment regimens work best. 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. If this red blood cell antioxidant is low, then you should not take methylene blue. Methylene blue was initially used as an antimalarial agent but is now is used to treat urinary tract infections and methemoglobinemia. 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. Oxacillin. Based on my observations, these herbal combination options have as good of a chance as the prescription options. Skip to content. Centers for Disease Control and Prevention. It can be helpful to use probiotics to restore the good bacteria and microbiome balance. Both psychotherapy and pharmacotherapy have proven benefits for improving mood. Cookies used to make website functionality more relevant to you. Persistent symptoms of Lyme disease are similar to and overlap with other conditions involving fatigue, pain, and cognitive symptoms. About 90 percent of the time when antibiotics are started or changed during a treatment, a person will initially worsen. However, this medicine will not work for colds, flu, or other virus infections. 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. Cefdinir is used to treat bacterial infections in many different parts of the body. Note: suvorexant ("Belsomra") is not recommended for patients being treated for Lyme disease as it can interact with many medications used by infectious disease doctors. Refer to Herxheimer Die-off Reaction: Inflammation Run Amok for a discussion of this and practical steps you can take to prevent or treat it. The goal was to repurpose already approved medications by screening medications from drug libraries. Inside of cells, Lyme exists without a cell covering known as an L-form. There are study design problems with the research studies of azithromycin and clarithromycin; therefore, it is hard to know whether they are truly less efficacious than the first-line agents for early Lyme disease. This means treatments should include antimicrobials that address persisters, in addition to the growth phase of the germ. In light of these research gaps, recommendations for treatment of persistent symptoms in people previously treated for Lyme disease are not provided here. Levofloxacin belongs to the class of medicines known as quinolone antibiotics. The state of the science relating to persistent symptoms associated with Lyme disease is limited, emerging, and unsettled. In 2020, the paper Evaluation of Disulfiram Drug Combinations and Identification of Other More Effective Combinations against Stationary Phase Borrelia burgdorferi was published. Minocycine and rifampin in this combination are also useful for treating a Bartonella co-infection. Because once injected, it cant be removed, it is important to make sure the individual is not allergic to this medication before initiating treatment. In a small number of the treated mice, however, bacteria were detected in their tissues. 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. For pediatric dosing, talk with your family physician or pediatrician. The researchers discovered the biofilm forms of Borrelia bacteria were more resistant to antibiotics that had good activity against round body persister forms suggesting antibiotics used alone had limited effect. 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. To help justify these various antimicrobial options, in this section I describe the experimental basis behind my recommendations. Rule 1: Combine antibiotics to treat all forms of the germ. The drug had great activity against inhibition and killing of the bacteria that causes Lyme. For the rifamycins, no laboratory experiments show these agents work against cysts. Ceftriaxone is typically given once a day intravenously, typically in 45 minutes. Note 1: Doxycycline raises the risk of sunburns due to increased skin sensitivity to sunlight. Cameron DJ, Johnson LB, Maloney EL. Because the suggestions listed below have not yet been studied in clinical trials of Lyme disease , these suggestions are based on evidence obtained from other disorders with similar clinical features. Both are better tolerated than the older macrolide antibiotic erythromycin in having fewer gastrointestinal side effects. Infect Drug Resist. Following up on previous results identifying disulfiram as a top hit, researchers wanted to perform studies on disulfiram in combinations with other antibiotics and additional combinations to determine the most effective. 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. Because of the intramuscular administration, the risk of gastrointestinal side effects and yeast infections are lower than with oral antibiotics. The researchers discovered 150 compounds that inhibited over 90% growth of Borrelia. Ceftriaxone is a third generation cephalosporin and, like other cephalosporins, is bacteriocidal. The results of these studies are helping the Lyme community move closer to finding a cure for chronic Lyme disease. Front Med (Lausanne). Some cephalosporin antibiotics were active against the persister forms of Borrelia. Levofloxacin comes as a tablet and a solution (liquid) to take by mouth. Additional researchexternal icon is needed to better understand how to treat, manage, and support people with persistent symptoms associated with Lyme disease. Erythromycin and clarithromycin can also lead to an increase in the blood levels of the anti-asthmatic drug, theophylline, which can put the patient at risk for seizures or arrhythmias. Expert Rev Anti-Infect Ther. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Highly sensitive laboratory tests were able to detect the presence ofB. burgdorferiin these mice. The mainstay of treatment is with oral (pill) antibiotics, but intravenous . These studies reinforced the evidence that patients reporting PTLDS symptoms have a severe impairment in overall physical health and quality of life. Cefazolin. These patients often show no evidence of active infection and may be diagnosed with post-treatment Lyme disease syndrome (PTLDS). This is an average. All information contained within the Johns Hopkins Lyme Disease Research Center website is intended for educational purposes only. Over time, most patients regain their cognitive function. These treatment regimens deliver effective drug levels that penetrate tissues and the brain. They appear to kill intracellular and extracellular Lyme, too, based on the clinical benefit I see in my medical practice. This herbal medicine is traditionally used to treat Babesia and malaria. For some with chronic Lyme disease, a cure does not occur. Stanford researchers that identified azlocillin as an effective antibiotic against stationary phase Borrelia in culture in 2016 performed another study in 2020, but this time with mice. They debuted about 30 years ago, around the time I was in medical school. Evaluation of in-vitro antibiotic susceptibility of different morphological forms of Borrelia burgdorferi. Levofloxacin may also be used to treat people who have been exposed to anthrax or certain types of plague. Cefuroxime works by disrupting cell wall synthesis and does cross the blood brain barrier to some extent. It is important to note that these studies were performed on cultures in a laboratory, and benefits may not directly translate in animal studies or humans. More recent work by replicated the earlier finding of persisting DNA but non-cultivatableB. burgdorferiafter antibiotic treatment using a mouse model. When memory is a problem, consider that this could be due to a primary problem with attention or with mood. Note: if one is penicillin allergic, there may be an increased risk of developing an allergic reaction to cefuroxime. This should be transient and last no more than a day or two after the initiation of antibiotics. The use of antibiotics is critical for treating Lyme disease. Dr. Liegners research shows that when disulfiram is used as a solo antibiotic, 36 percent of people can enter a period of extended remission. Another study challenged the interpretation of the results on statistical grounds, a position not accepted by the study authors. Lyme disease encompasses a range of biologic processes and disease manifestations. However, the prognosis worsens when diagnosis and treatment are delayed. Both regimens have some published clinical evidence of benefit. Some of these effects may not go away, and may lead to . Buhner SH. Antimicrob Agents Chemother. (See IV Equivalent Treatments below. It treats a variety of infections, including MRSA (methicillin-resistant Staphylococcus aureus) skin infections and vaginal infections. Notably, many persisting Lyme disease symptoms overlap with other infection-associated chronic illnesses such as Long COVID and ME/CFS, and additional studies are needed to determine if they may share some common biologic pathways. It should be noted however that to obtain the pain relief from a medication such as venlafaxine, in most patients the dose needs to be increased to 225-300 mg/day in order to obtain the benefits for pain and mood. The most common side effect of the penicillin antibiotics is diarrhea, and occasionally even serious cases caused by the bacteria Clostridium difficile. I consider this dose nearly as effective as IV antibiotics. For depression the first-line options usually are SSRIs, SNRIs, Tricyclics or other agents with more unique modes of action. 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