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.
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.
Description Of The Intervention
People with the characteristic skin lesion of Lyme disease, erythema migrans, followed by manifestations of infection of the nervous system, referred to as LNB, were successfully treated with antibiotics as early as 1948 . Treatment with antibiotics capable of crossing the bloodbrain barrier is now the standard of care for people diagnosed with LNB. However, no placebocontrolled trials have ever been performed, and the antibiotic of choice, route of administration, dose, and length of treatment for LNB remain controversial.
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For Memory Concentration And Focus
Improving memory is a challenge. In Lyme disease, short-term memory problems and word-retrieval problems are common. These often improve substantially with appropriate antibiotic therapy. Over time, most patients regain their cognitive function.
When memory is a problem, consider that this could due to a primary problem with attention or with mood. An individual who can’t focus won’t be able to remember because he/she didn’t “attend” to the item in the first place. 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. 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.
- Medications: Attention can be improved with certain medications, such as bupropion , atomoxetine , modafinil , or stimulants . Medications that temporarily slow cognitive decline in Alzheimer’s disease or memantine ) have not been studied in Lyme disease.
- There is some evidence that online brain training programs can enhance concentration or processing speed.
- Neurofeedback may be helpful in improving attention, as well as in improving sleep and reducing pain. This has been studied for migraines, fibromyalgia, and ADHD.
What Is Post Treatment Lyme Disease
Post Treatment Lyme Disease represents a research subset of patients who remain significantly ill 6 months or more following standard antibiotic therapy for Lyme disease. 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. In the absence of a direct diagnostic biomarker blood test, PTLD has been difficult to define by physicians, and its existence has been controversial. However, our clinical research shows that meticulous patient evaluation when used alongside appropriate diagnostic testing can reliably identify patients with a history of previously treated Lyme disease who display the typical symptom patterns of PTLD.
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What Is The Treatment
Most cases of Lyme disease can be effectively treated with 2 to 4 weeks of antibiotics. Depending on the symptoms and when you were diagnosed, you may require a longer course or repeat treatment with antibiotics.
Some people experience symptoms that continue more than 6 months after treatment. Research continues into the causes of these persistent symptoms and possible treatment methods.
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.
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How Is Lyme Disease Treated
Lyme disease is treated with antibiotics.
The type of antibiotic your doctor gives you and the number of days you take it will depend on your symptoms and the stage of the disease. Talk to your doctor if you have any questions about your antibiotic treatment.
Antibiotic treatment for early Lyme disease works well. Symptoms usually go away within 3 weeks of starting treatment.
The earlier you start this treatment after infection, the faster and more completely you will recover.
It’s important to get treatment for Lyme disease as soon as you can. If it’s not treated, Lyme disease can lead to problems with your skin, joints, nervous system, and heart. These can occur weeks, months, or even years after your tick bite. The problems often get better with antibiotics. But in rare cases, they can last the rest of your life.
If the disease gets worse, treatment options include:
People with partial facial paralysis as a result of Lyme disease may improve on their own without more treatment.
Even after successful treatment for Lyme disease, you can get it again. So it’s important to keep protecting yourself against tick bites.
Awareness Of Lyme Disease
1.1.1 Be aware that:
the bacteria that cause Lyme disease are transmitted by the bite of an infected tick
ticks are mainly found in grassy and wooded areas, including urban gardens and parks
tick bites may not always be noticed
infected ticks are found throughout the UK and Ireland, and although some areas appear to have a higher prevalence of infected ticks, prevalence data are incomplete
particularly high-risk areas are the South of England and Scottish Highlands but infection can occur in many areas
Lyme disease may be more prevalent in parts of central, eastern and northern Europe and parts of Asia, the US and Canada.
1.1.2 Be aware that most tick bites do not transmit Lyme disease and that prompt, correct removal of the tick reduces the risk of transmission.
1.1.3 Give people advice about:
where ticks are commonly found
the importance of prompt, correct tick removal and how to do this
covering exposed skin and using insect repellents that protect against ticks
how to check themselves and their children for ticks on the skin
sources of information on Lyme disease, such as Public Health England’s resources and guidance on Lyme disease and organisations providing information and support, such as patient charities.
For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on awareness of Lyme disease.
Description Of The Condition
Lyme neuroborreliosis is a group of diseases that can affect the central nervous system and the peripheral nervous system , or both, as a result of infection with or the postinfectious consequences of different species of the spirochete bacterium Borrelia burgdorferi. These organisms are transmitted by ixodid ticks in endemic areas in the United States and Europe. Although a multitude of clinical manifestations of LNB have been reported, the most common are radicular pains, facial paralysis, and meningitis, referred to as Bannwarth’s syndrome in Europe . It was not until 1981 that entomologist Willy Burgdorfer and colleagues in the United States suspected that the cause of Lyme disease was a tickborne spirochete . In the decades since the identification of B. burgdorferi, it has become clear that LNB is one of the most common and important complications of Lyme disease. The diagnosis of LNB requires confirmation of infection with B. burgdorferi plus evidence of involvement of the CNS, the PNS, or both. According to the Centers for Disease Control and Prevention, from the 154,405 cases of Lyme disease reported during 2001 to 2010 in the United States, 14% were identified with facial palsy, radiculoneuropathy, meningitis, or encephalitis . Looking at Lyme disease occurring in Europe, others have estimated that up to 12% of cases have neurological manifestations , and that approximately 5% of individuals with an untreated erythema migrans will develop LNB .
Picc Line For Lyme Disease:
PICC stands for peripherally inserted central catheter. Inserting a PICC line is a common procedure in which a thin, flexible tube will be inserted into a large vein in the upper arm. The tube will be threaded through the vein until it rests just above the heart. A technician will use a numbing agent so there is no pain and the tube will be guided through the vein with the help of ultrasound and/or X-ray. A PICC line can stay in place for several weeks or months without needing to be changed or taken out. It is a more effective way of delivering IV antibiotics into your body if you intend to be using them on a regular basis. The placement of the tube just above the heart allows for a quicker response time for medications and nutrients, etc. If done properly, once the line is in and the initial discomfort settles, it shouldnt be at all noticeable.
Each infusion with a PICC line will take anywhere from 30 minutes to an hour and a half and can be done at your own home either on your own or via a visiting nurse. Otherwise, infusions will be done at a hospital infusion lab or doctors office. PICC lines require regular cleaning by a nurse, either in home or at a facility.
This procedure should be taken seriously and adequate discussion and caution should be used when considering a PICC line with your doctor.
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Protocols For Iv Therapy
You must work with a doctor who specializes in treating Lyme disease with IV antibiotic therapies. They are the doctors with the proper equipment and alternative treatments available in their office.
Lyme literate doctors will create a protocol of therapy individualized to ease your specific symptoms. The protocols will include both antibiotic and alternative regimens.
The antibiotic treatment will include antimicrobial substances that fight against infections, viruses, parasites, yeast, and fungi. They can go anywhere in the body to fight, even cells and cell membranes.
Therapy Silver given intravenously compliment IV antibiotic treatments. Silver has been used for centuries in treating ailments. Lyme disease has been shown to prevent bacteria from replicating. It can also bind to hard to flush out viruses. Once it locks on, the virus is easily eliminated.
Vitamins given through IV are a therapy finding great popularity with people with Lyme disease and anyone else who feels depleted or who is struggling with some ailment. Vitamin C Mega Dose is one example that helps your own bodys immune system gets boosted so that it can participate in the elimination of Lyme.
What Factors Determine How Patients Respond To Treatment
To find out what made some patient substantially improve or become well, we turned to our academic partners at the University of California at Los Angeles who specialize in artificial intelligence and machine learning. Their team looked at 215 features related to diagnostic factors, treatment approach, duration of individual antibiotics, alternative treatments, symptoms, type of clinician, and functional impairment to identify the 30 top predictive features for treatment response . Most of the top 30 features identified in their study related to chronic Lyme disease treatment , symptom severity , and type of clinician treating Lyme disease. We analyzed three of these factors associated with treatment response:
- Treatment approach
- Treatment durations
- Type of clinician overseeing the patients care
Evaluation According To Protocol
Patients were required to have pretreatment serological testing, lumbar puncture, neuro-psychological testing, and brain MRI. The antibody response to B. burgdorferi in serum was determined by indirect ELISA and Western blotting , and positive results were interpreted according to the CDC/ASTPHLD criteria . Spinal fluid was tested for total cells and protein, and concomitant serum and CSF samples were tested for intrathecal IgM, IgG, and IgA antibody production to B. burgdorferi by antibody capture enzyme assay, as previously described . A response in CSF that was> 1 times that in serum was defined as local synthesis of specific antibody in CSF. B. burgdorferi DNA was detected in CSF by PCR by use of 2 different primer-probe sets that target different regions of the plasmid DNA encoding outer-surface protein A of the spirochete, as previously described .
Routine brain MRI, without gadolinium enhancement, was performed in all patients. After August 1992, it became possible to perform quantitative single photon emission computed tomography of the brain, newly reported in one study to be of use in evaluation of Lyme encephalopathy . SPECT was not available when the study began, and only the last 7 patients entered into the study underwent SPECT imaging.
Oral Antibiotics For Early Treatment Of Lyme
The bacteria involved in spreading Lyme disease throughout the body are intelligent. They find ways to hide in the bloodstream along the lining, making it hard for antibiotics to find and attack. The bacteria are also robust. They can move and replicate even when traveling against the flow of blood.
Plus, to eliminate Lyme bacteria, Borrelia burgdorferi, the bacterias antibodies must be present at the time of antibiotic treatment. This means that if your doctor prescribes antibiotics for two weeks, the bacteria are in hibernation during those two weeks, and they can remain after the treatment ends.
Timing is everything when using oral antibiotics. This becomes even more true for patients who have had Lyme disease for a long time. Oral antibiotics are not as successful when treating late or chronic Lyme disease, plus they can have side effects.
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Treatment For Other Forms Of Lyme Disease
People with other forms of disseminated Lyme disease may require longer courses of antibiotics or intravenous treatment with antibiotics such as ceftriaxone. For more information about treating other forms of Lyme disease, see:
The National Institutes of Health has funded several studies on the treatment of Lyme disease that show most people recover within a few weeks of completing a course of oral antibiotics when treated soon after symptom onset. In a small percentage of cases, symptoms such as fatigue and myalgia can last for more than 6 months. This condition is known as post-treatment Lyme disease syndrome , although it is also sometimes called chronic Lyme disease. For details on research into chronic Lyme disease and long-term treatment trials sponsored by NIH, visit the visit the National Institutes of Health Lyme Disease web siteexternal icon.
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.
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Concern Over Resistance Other Complications
According to the CDC, it is not known how many people seek treatment for chronic Lyme, or how many complications occur during the course of treatment.
“In addition to the dangers associated with inappropriate antibiotic use, such as selection of antibiotic-resistant bacteria, these treatments can lead to injuries related to unnecessary procedures, bacteremia and resulting metastatic infection, venous thromboses, and missed opportunities to diagnose and treat the actual underlying cause of the patients symptoms,” the authors conclude.
For Depression And Anxiety
Both psychotherapy and pharmacotherapy have proven benefits for improving mood. Psychotherapy has many different types such as supportive, dynamic, cognitive behavioral, dialectical behavior therapy, transference focused psychotherapy each of which offers benefit. Pharmacotherapy also has many different types. For depression the first-line options usually are SSRIs, SNRIs, Tricyclics or other agents with more unique modes of action.
A few noteworthy tips on anti-depressant agents:
- Most anti-depressant agents also help in reducing anxiety. However the opposite isn’t necessarily true. Specific anti-anxiety agents such as clonazepam or diazepam may not necessarily help fight depression.
- Most anti-depressants take three to eight weeks before an effect is seen. 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.
- Dosage makes a difference. Some anti-depressants work fine at low doses some medications however are effective only at higher doses. Some medications are more effective as the dose is i increased. Other antidepressants may have a therapeutic range one has to achieve at least a certain dosage .
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