Monday, November 28, 2022

Antibiotics For Lyme Disease In Humans

Iv Antibiotic Regimen: Cephalosporin Plus Azole Plus Liposomal Cinnamon Clove And Oregano

Lyme Disease Is On The Rise. And It’s Bad.
  • ceftriaxone 2 gm IV 2 times a day for 4 days on and 3 days off
  • tinidazole 500 mg taken orally 1 pill 2-3 times a day for 4 days on and 3 days off in 7-day cycles
  • liposomal cinnamon, clove, and oregano capsules 1 pill 2 times a day

Key Points:

  • Various antibiotics can be used as IV. I use this one most commonly because it is the easiest to administer and one of the lowest cost IV regimens. The ceftriaxone is given in a syringe and injected over 10 minutes. This is also a pulse dose regimen . Ceftriaxone could be given daily instead as 2 gm IV 1 time a day.
  • I have found various pulse dose regimens of tinidazole to work. These include 2 weeks on and 2 weeks off or in the regimen seen here.

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 To Prevent Post

While you may not be able to prevent post-treatment Lyme disease syndrome, you can take precautions to prevent coming into direct contact with infected ticks. The following practices can reduce your likelihood of getting Lyme disease and developing persistent symptoms.

If a tick bites you, contact your doctor. You should be observed for 30 days for signs of Lyme disease. You should also learn the signs of early Lyme disease and seek prompt treatment if you think youre infected. Early antibiotic intervention may reduce your risk of developing chronic symptoms.

The signs of early Lyme disease can occur from 3 to 30 days after a bite from an infected tick. Look for:

  • a red, expanding bulls-eye rash at the site of the tick bite

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Ongoing Symptoms Of Lyme Disease

A few people who are diagnosed and treated for Lyme disease continue to have symptoms, like tiredness, aches and loss of energy, that can last for years.

These symptoms are often compared to fibromyalgia and chronic fatigue syndrome.

It’s not clear why this happens to some people and not others. This means there’s also no agreed treatment.

Speak to a doctor if your symptoms come back, or do not improve, after treatment with antibiotics.

The doctor may be able to offer you further support if needed, such as:

  • referral for a care needs assessment
  • telling your employer, school or higher education institution that you require a gradual return to activities
  • communicating with children and families’ social care

Page last reviewed: 05 July 2021 Next review due: 05 July 2024

Other Natural Treatments For Lyme Disease

Intravenous Antibiotics Injection for Lyme Disease Patients

The treatments discussed above are only some of the natural treatments that claim to treat Lyme disease. According to a 2015 study looking at the alternative treatments found during an Internet search, other natural treatments people use for Lyme disease include:

  • saunas and steam rooms

The investigators noted that theres no research backing up these treatments, any many dont have a logical rationale behind them.

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The Chance Of Getting Lyme Disease

Not all ticks in England carry the bacteria that causes Lyme disease.

But it’s still important to be aware of ticks and to safely remove them as soon as possible, just in case.

Ticks that may cause Lyme disease are found all over the UK, but high-risk places include grassy and wooded areas in southern and northern England and the Scottish Highlands.

Ticks are tiny spider-like creatures that live in woods, areas with long grass, and sometimes in urban parks and gardens. They’re found all over the UK.

Ticks do not jump or fly. They attach to the skin of animals or humans that brush past them.

Once a tick bites into the skin, it feeds on blood for a few days before dropping off.

Background And Diagnosis Of Late Neurologic Lyme Disease

Late neurologic Lyme disease may present as encephalomyelitis, peripheral neuropathy, or encephalopathy . Because most patients with Lyme disease are now diagnosed and treated early in the course of infection, these more indolent forms of neurologic Lyme disease are quite rare. Encephalomyelitis is a unifocal or multifocal inflammatory CNS disease . Collectively, only 1 patient with encephalomyelitis has been diagnosed over the past 5 years by panel members , in spite of both community-based and referral clinical practices. This severe neurologic manifestation of Lyme disease has been diagnosed primarily in Europe.

In untreated patients, encephalomyelitis has been monophasic and slowly progressive, principally involving white matter. Two-tier seropositivity with serum samples and evidence of intrathecal antibody production to B. burgdorferi are expected . Intrathecal antibody production, however, may persist for years following successful treatment, so this parameter does not provide a useful marker of disease activity . CSF examination typically shows a lymphocytic pleocytosis, a moderately elevated protein level, and a normal glucose level . Sensitivity of PCR for detection of B. burgdorferi DNA in the CSF of such patients is extremely low. MRI of the affected part of the neuraxis can demonstrate areas of inflammation, typically with increased signal on T2 and FLAIR imaging and enhancement following contrast administration .

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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 Is The Treatment For Lyme Disease

Lyme Disease Prophylaxis After Tick Bite

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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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.

What Are The Treatments For Lyme Disease

Lyme disease is treated with antibiotics. The earlier you are treated, the better it gives you the best chance of fully recovering quickly.

After treatment, some patients may still have pain, fatigue, or difficulty thinking that lasts more than 6 months. This is called post-treatment Lyme disease syndrome . Researchers donât know why some people have PTLDS. There is no proven treatment for PTLDS long-term antibiotics have not been shown to help. However, there are ways to help with the symptoms of PTLDS. If you have been treated for Lyme disease and still feel unwell, contact your health care provider about how to manage your symptoms. Most people do get better with time. But it can take several months before you feel all better.

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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.

Why Are Antibiotics The First Line Of Treatment For Lyme Disease

Lyme Disease Antibiotic Myth

The use of antibiotics is critical for treating Lyme disease. Without antibiotic treatment, the Lyme disease causing bacteria can evade the host immune system, disseminate through the blood stream, and persist in the body. Antibiotics go into the bacteria preferentially and either stop the multiplication of the bacteria or disrupt the cell wall of the bacteria and kill the bacteria . By stopping the growth or killing the bacteria the human host immune response is given a leg up to eradicate the residual infection. Without antibiotics, the infection in Lyme disease can evade the host immune system and more readily persist.

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Background And Diagnosis Of Borrelial Lymphocytoma

Borrelial lymphocytoma is a rare cutaneous manifestation of Lyme disease in Europe, which presents as a solitary bluish-red swelling with a diameter of up to a few centimeters . The most common site of borrelial lymphocytoma is the ear lobe in children and the breast, on or near the nipple, in adults. Mild, localized discomfort often accompanies the skin lesion. Borrelial lymphocytoma is characterized histologically by a dense polyclonal and predominantly B lymphocytic infiltration of the cutis and subcutis, frequently with germinal center formation . Borrelial lymphocytoma may be the only sign of Lyme disease or merely one of several manifestations during the course of the illness. It often appears near the site of a prior tick bite and frequently arises in the vicinity of a previous or concurrent erythema migrans lesion, but compared with erythema migrans, it usually emerges later and lasts longer .

Treatment For Erythema Migrans

People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Early diagnosis and proper antibiotic treatment of Lyme disease can help prevent late Lyme disease.

Treatment regimens listed in the following table are for the erythema migrans rash, the most common manifestation of early Lyme disease. These regimens may need to be adjusted depending on a persons age, medical history, underlying health conditions, pregnancy status, or allergies. Consult an infectious disease specialist regarding individual patient treatment decisions.

Treatment regimens for localized Lyme disease.

Age Category
30 mg/kg per day orally, divided into 2 doses 500 mg per dose

*When different durations of antibiotics are shown to be effective for the treatment of Lyme disease, the shorter duration is preferred to minimize unnecessary antibiotics that might result in adverse effects, including infectious diarrhea and antimicrobial resistance.

NOTE:For people intolerant of amoxicillin, doxycycline, and cefuroxime, the macrolide azithromycin may be used, although it is less effective. People treated with azithromycin should be closely monitored to ensure that symptoms resolve.

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What To Do If You Find A Tick

If you see a tick, try to remove it from your childs body. If the tick was on the body for less than 36 hours, it may help prevent infection.

To safely remove a tick:

  • Use fine-tipped tweezers to grasp the tick at its head or mouth, close to the skin.
  • Pull firmly on the tick until it releases the skin. Try to ease out any parts that get stuck in the skin.
  • Wash the bite area with rubbing alcohol or soap and water and apply an antiseptic lotion or cream.

Trial Design And Study Characteristics

Doxycycline and Lyme Disease Treatment

Table summarizes the study design of the four randomized, double-blind, placebo-controlled trials included for analysis. All four trials were conducted in areas where Lyme disease is endemic and all trials enrolled patients with an Ixodes scapularis tick bite within the preceding 72 h. In all four trials, the blinding of patients was performed by giving them identical-appearing tablets, capsules or liquid suspensions. The success of patient blinding was assessed in only one study. In all four trials, physicians were reported to be blinded to the treatment allocation. However, no trial reported how physician blinding was assessed. Two trials assessed patient compliance: the first measured patient compliance by assessing the antimicrobial activity of patient urine and the other asked subjects to swallow the single-dose regimen under direct observation by study personnel.

All of the four clinical trials used the development of erythema migrans or symptoms of extracutaneous Lyme disease as their primary outcome for statistical analysis. All trials measured serum antibodies against B. burgdorferiat presentation and upon follow-up. Only two trials, confirmed equivocal or positive results with immunoblot assays.

Dosage, duration and types of antibiotics tested varied among trials. In three trials, a 10 day course of treatment was administered. In the other trial, subjects were given two 100 mg capsules of doxycycline as a single dose.

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What Blacklegged Ticks Look Like

Blacklegged ticks are small and hard to see. They attach themselves to humans and animals and feed on their blood. They can range in size depending on how long they have been feeding.

You can find out if its a blacklegged tick by:

Adult female blacklegged tick at various stages of feeding. Photo: Government of Canada

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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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How Do I Treat Lyme Disease Naturally

Some people may choose home remedies and natural treatments to help treat Lyme disease. Certain lifestyle changes may help symptoms from worsening or recurring. Many natural supplements are not approved by the FDA. Here are some popular home and natural remedies for Lyme disease:

  • Taking a natural supplement Many supplements are thought to have immune-boosting qualities. Top supplements for Lyme disease include vitamin B-1, vitamin C, and chlorella. The FDA doesnt regulate supplements as drugs to treat Lyme disease, so speak with a doctor about them before starting treatment.
  • Using essential oils Some essential oils are known for their antibacterial properties. Oregano and cinnamon bark essential oils are highly antibacterial they would have to be mixed with a carrier oil and applied topically. However, more evidence is needed on the use of essential oils for Lyme disease in humans.
  • Eating an anti-inflammatory diet Lyme disease symptoms are often rooted from inflammation in the body. Avoiding foods that can cause more inflammation, such as sugar, coffee, or processed foods, may help. Fresh fruits and vegetables are believed to have anti-inflammatory benefits.
  • Seeking acupuncture treatmentAcupuncture can potentially relieve symptoms associated with Lyme disease such as pain, sleeplessness, and stress.
  • Reducing stressYou can reduce stress by exercising, sleeping more, meditating, or spending time with friends and family.

What Are The Clinical Manifestations Of Ld

Developing New Guidelines on Lyme Disease

Clinical manifestations are divided into early, localized disease, and later disease.

Early, localized disease: Erythema migrans a rash at the site of a recent tick bite is the most common presentation in children and adults . EM typically develops seven to 14 days after a tick bite. EM is usually > 5 cm and mainly flat. There may be central clearing or some bluish discoloration but a classic bulls eye is uncommon. EM is usually asymptomatic but is not painful to the touch, like a cellulitis. EM can be confused with a localized hypersensitivity reaction from a tick or insect bite, which is usually swollen, smaller in size and pruritic). There can be either a single erythema migrans rash or multiple rashes without extracutaneous manifestations. However, fever, malaise, headache, mild neck stiffness, myalgia and arthralgia often accompany EM.

Without treatment, EM resolves spontaneously over a four-week period, on average.

Later disease: Approximately 20% of children with LD first present to a health care provider with extracutaneous signs or symptoms that are compatible with LD. These cases may also have a recent past history of EM lesions and non-specific low-grade fever, myalgia, and fatigue upon questioning further.

Figure 4) Erythema migrans rash showing the classic bulls eye form. Reproduced from reference 1 © All rights reserved. With permission from the Minister of Health, 2014

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