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. Clinically, I see great benefit in using the rifamycins as my anti-cyst agents, so I list them here. On average, it can take two years to recover for someone with chronic Lyme. 2020;9(9):633. doi:10.3390/antibiotics9090633(, Sapi E, Kaur N, Anyanwu S, et al. I recommend disulfiram-only regimens to people who have taken extensive numbers of antibiotics for a year or more of treatment and remain ill. In this situation, symptom-based therapies can be quite helpful. LEARN MORE ABOUT OPPORTUNITIES TO PARTICIPATE IN OUR RESEARCH STUDIES, 2023 Johns Hopkins Lyme Disease Research CenterPatient Privacy, Lyme Disease Prevention, Tick Removal, & Health and Wellness Tips, Lyme and Tickborne Disease Fellowship Program, Potential mechanisms of persistent symptoms in Lyme disease. Benzathine Penicillin is an intramuscular form of penicillin that has the advantage of being long-acting and allowing for consistently high blood and tissue levels of penicillin. Arthritis Center News Amoxicillin/clavulanate (Augmentin) Augmentin is a combination antibiotic that contains amoxicillin and clavulanate. Previous enrollment in this study. Antibiotics (Basel). 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. Evidence of uncontrolled clinically significant cardiovascular, pulmonary, metabolic, gastrointestinal, neurological or endocrine disease, malignancy, or other abnormality (other than the disease being studied). Drug combinations were most effective at eradicating stationary phase Borrelia burgdorferi. This is why most of the antibiotics prescribed to . Both regimens have some published clinical evidence of benefit. The antibiotic moxifloxacin had good inhibitory effect against stationary phase Borrelia but was not a top hit for the growing form of Lyme bacteria. Another team of NIAID-supported investigators found that intactB. burgdorferipersist in nonhuman primates after antibiotic treatment. Combine antibiotics that work in different ways to attack the germ from different angles. Lyme disease SULFONAMIDES - inhibit the biosynthesis of folic acid in bacterial cells - bacteriostatic - wide spectrum including S. pyogenes, S. pneumoniae, H. influenzae Trimethoprim-sulfamethoxazole (TMP-SMZ) (po, IV - Bactrim) Daptomycin is an intravenous antibiotic and had the highest activity against the persister phase of Borrelia but was not effective against the growth phase. 2015;4(3):397-410. doi:10.3390/antibiotics4030397, Feng J, Zhang S, Shi W, Zubcevik N, Miklossy J, Zhang Y. Qigong is a mind-body-spirit practice that integrates posture, movement, breathing technique, self-massage, sound, and focused attention. 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. He is a member of the International Lyme and Associated Disease Society (ILADS) , The Institute for Functional Medicine, and The American Academy of Anti-Aging Medicine. The ideas and recommendations on this website and in this article are for informational purposes only. Ying Zhang, MD and colleagues at Johns Hopkins found disulfiram does not work against Bartonella, however. NIAID-supported studies have shown thatB. burgdorferican be detected in mice for at least three months after treatment with therapeutic doses of various antibiotics (ceftriaxone, doxycycline, or azithromycin). It works by killing bacteria or preventing their growth. Lyme does not easily develop herbal antibiotic resistance. Rule 1. Both psychotherapy and pharmacotherapy have proven benefits for improving mood. None of the antibiotics in current use for Lyme disease were developed for the bacteria that causes Lyme. PTLD is characterized by a constellation of symptoms that includes severe fatigue, musculoskeletal pain, sleep disturbance, depression, and cognitive problems such as difficulty with short-term memory, speed of thinking, or multi-tasking. Both are better tolerated than the older macrolide antibiotic erythromycin in having fewer gastrointestinal side effects. In 2022, our Center began its first two treatment trials for patients with Lyme disease infection associated chronic illness. Grapefruit seed extract is better tolerated than both tinidazole and metronidazole and supports killing of Lyme cysts. Therefore, in people who have failed years of antibiotics, without an active co-infection, I recommend a trial of disulfiram alone. One or more of these underlying causes may be occurring simultaneously. Patients should also keep an open mind regarding what might help, as some symptoms may reflect active infection (and therefore benefit from antibiotics) while others may reflect the residual effects on the body of the prior infection (and therefore require non-antibiotic approaches). Since the drugs used in the screening studies were from research drug libraries, some of the effective medications are not available commercially. Richard Horowitz, MD has promoted the use of dapsone-based regimens to treat both Lyme and Bartonella persisters. They also determined that the combination of azlocillin and cefotaxime was more effective at killing Borrelia persisters than azlocillin alone. Since azithromycin is not as effective as other macrolides like clarithromycin, hydroxychloroquine is used to increase the effectiveness. He researched both a 100 mg dapsone protocol and a 200 mg dapsone protocol. This herbal medicine is traditionally used to treat Lyme and Bartonella as described in the various books by master herbalist Stephen Buhner. After extensive antibiotic treatment, approximately 10% of late Lyme arthritis patients remain symptomatic with a condition termed antibiotic refractory late Lyme arthritis. In Lyme disease, short-term memory problems and word-retrieval problems are common. Lyme disease encompasses a range of biologic processes and disease manifestations. 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. Ciprofloxacin (Cipro) and levofloxacin (Levaquin) are antibiotics that keep bacteria from copying their DNA and multiplying. Cefdinir [Omnicef] 300 mg twice daily or 600 mg once . Of the various herbal options to treat persisters, this is my go-to herbal anti-microbial based on benefits I see in my practice. Dapsone for Lyme Persisters. While Cefotaxime is less likely to cause gallstones, it requires 3x daily dosing which for most patients is too difficult to maintain. Researchers studied 37 individuals with well-documented Lyme disease, at least three weeks of prior intravenous antibiotics, a current positive Lyme test (IgG Western blot), and self-reported memory impairment. Established name: cefdinir . Rule 3. Levofloxacin may also be used to treat people who have been exposed to anthrax or certain types of plague. The antibiotics with the most significant activity against persister Borrelia bacteria were daptomycin, clofazimine, carbomycin, some cephalosporins, and some sulfa drugs. Azithromycin and clarithromycin are macrolide antibiotics that have been studied in humans for the treatment of Lyme disease. The following treatment regimens reflect CDCs interpretation of the most current data for four important manifestations of Lyme disease. "Drug Therapy Individualization for Patients with Chronic Kidney Disease." Pharmacotherapy: A Pathophysiologic Apprach, 10e Eds. A severe allergic reaction known as anaphylaxis is a medical emergency that requires immediate attention. 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. 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. 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. The blood levels after benzathine penicillin are almost as high as after IV ceftriaxone. As with all recommendations on this website, the taking of over-the-counter or prescribed medications should be carefully reviewed with a physician to ensure safety and efficacy and to assess for potentially harmful drug interactions. Inside of cells, Lyme exists without a cell covering known as an L-form. The limitation of most of these studies is that they were performed in vitro (outside of a living organism), but they establish a starting point for future in vivo studies. 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). 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. These types of antibiotics work slightly better than amoxicillin/potassium clavulanate, cefdinir, and cephalexin. Research first published in 2015 shows that Lyme has two different growth states. Any antibiotic can cause skin rashes, and if an itchy red rash develops while on antibiotics, a patient should see their physician. Levofloxacin (po, IV - Levaquin) Bronchitis, community acquired pneumonia, UTI and sinusitis . In a 2008 study, mice were treated with the antibiotic ceftriaxone for one month following either early or later stages of infection withB. burgdorferi. However, the prognosis worsens when diagnosis and treatment are delayed. Join our mailing list to receive the latest news and updates fromJohns Hopkins Rheumatology and the Johns Hopkins Lyme Disease Research Center. As with other cephalosporins, bactericidal activity of cefdinir results from inhibition of cell wall synthesis. These treatment regimens deliver effective drug levels that penetrate tissues and the brain. If a person also has Babesia, cryptolepis can treat this, too. Healing Lyme: Natural Healing of Lyme Borreliosis and the Coinfections Chlamydia and Spotted Fever Rickettsioses. 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. Arthritic pain that persists after antibiotic therapy may be reduced by nonsteroidal anti-inflammatory drugs (NSAIDS) that reduce inflammation. 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. For example, erythromycin or clarithromycin can lead to dangerously increased blood levels of the anticonvulsant drug carbamazepine (Tegretol) as well as increases in the anti-anxiety drug alprazolam (Xanax). Of the various herbal options listed here, this is my go-to favorite based on the clinical benefits I see in my practice. Because of this, drug-drug interactions can occur. Methylene blue is approved to treat a problem called methemoglobinemia where methylene blue causes hemoglobin to release oxygen. He helps Lyme sufferers and their physicians see what really works based on his review of the science and extensive real-world experience. This has been studied for migraines, fibromyalgia, and ADHD. NIAID, in collaboration with NINDS, supported comprehensive studies on non-human primates looking at the neuropathology associated with post-treatment Lyme disease syndrome. However, I find herbal antibiotics work well for a year or more without changing the herbs. Therefore prior to any thereapeutic intervention (e.g, medicinal, herbal, diet change, even exercise), individuals need to review how this intervention might impact them. For some with chronic Lyme disease, a cure does not occur. Therefore, patients need to remember to flush their PICC or Mid-line daily, to keep the PICC line site clean, and to not engage in jerky arm movements, such as might occur when washing windows or playing tennis or golf. The focus of this article is on Lyme germ treatment. This medicine may cause severe side effects like irritated or torn tendons; nerve problems in the arms, hands, legs, or feet; and nervous system problems. Interestingly, the alcohol abuse medication disulfiram was effective against Borrelia. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site. (See Pulse Dosing below.). 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. Rule 4: Treat all growth phases of Lyme at the same time. These options are ones I am using with various degrees of success in my Seattle practice. However, when behavioral changes don't work, pharmacologic therapies should be considered. The antibiotics commonly prescribed for Lyme disease are ineffective against chronic or persistent Lyme disease. Saving Lives, Protecting People, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Laboratory tests that are not recommended, HHS federal research updates on Lyme disease diagnostics, Surveillance explained and available data, U.S. Department of Health & Human Services. That study had two important differences from the previous trials. Similar to disulfiram, dapsone-based treatment is a harsh regimen with nearly 40 percent of people dropping out of treatment due to side effects. The drug had great activity against inhibition and killing of the bacteria that causes Lyme. The goal is to restore one's health and functional status so as to maximize quality of life. 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