USING ANTIBIOTICS IN LYME DISEASE
Although Lyme-Disease is initially caused by an infection, the spirochete itself
may not even be present in later stage disease. The body is most likely suffering from an
auto-immune problem. The infecting organism stimulated an immune response in the
body. Even if the bug has been cleared from the system, the auto-immune process can
persist.
Antibiotics still function in this environment. These medicines may block the
harmful effects of the body’s attack upon itself. There are probably several reasons why
antibiotics help people feel better even when there is no active infection. Hopefully
future researchers will recognize that people without documented infections still respond
to antibiotics. Then the mechanism of these benefits will be sought. In the meantime, if
you are suffering and cannot live your life, and if nothing but antibiotics help, then that is
your treatment.
There is no defined program for using antibiotics to treat Lyme Disease. Instead
of a cookbook, we are entering a maze of possibilities. There will be trial and error to
find the best response. Once you have found a treatment regimen that works, you may
have to adjust it along the way. It all depends on how you respond. If a medicine helps
you without causing prolonged or moderately serious side effects, then that is a good
therapy. If it loses its effectiveness or you stop making regular progress toward
improvement, then you need to make a change.
My usual first choice is doxycycline 100 mg. twice a day with meals. It can cause
nausea. If this is not tolerated, I switch to cefuroxime 500 mg. twice a day.
Depending on the response, I may double the dose of doxycycline, or add
metronidazole (flagyl) 500 mg. 3 times a day with food, or switch to a different
antibiotic. The most commonly used choices are clarithromycin (biaxin) 500 mg. twice a
day, azithromycin (Zithromax) 250 mg. once a day, amoxicillin 500 mg. 3 times a day,
minocycline 100 mg. once a day, and sulfamethoxazole-trimethoprim DS (Bactrim DS)
twice a day. If 2 work, I might give both together.
When there is a response, I have found that adding an anti-fungal medicine
enhances the therapy. Adding nystatin 500,000 unit tablets (3 pills twice a day) or
fluconazole (diflucan) 100 mg. once a day are useful.
When there is a response, increasing diflucan to 200 mg. daily or Zithromax to
500 mg. daily are worthwhile trials.
Other types of antimicrobials are also helpful, especially when there is a response
but even if there is not. The anti-malarial hydroxychloroquine (plaquenil) 200 mg. a day
is good for many people. The antiprotozoal medicine atovaquone (mepron) – which
dosed by weight – is often useful. I usually use this in a pulsing manner: taken for 10
days and off for 20 days. The TB medicine Rifampin 300 mg. once or twice a day
[depending on the response and side effects] has given favorable benefits to many.
If this sounds confusing, that is probably because it is. There is no set pattern.
There are many combinations of these medicines. Finding the right one is a challenge.
But the first ones listed above work most often. Some doctors have detailed written
protocols for how to use antibiotics. You can certainly find these, but I have found the
trial and error method most successful.
If you have a blood test that is positive for Lyme by CDC criteria, then it may be
possible to prescribe intravenous antibiotics. It is too expensive if insurance does not
pay. Some people respond greater from this. The most common is ceftriaxone
(Rocephin). The dose is 2 grams IV once or twice a day. There is a risk of developing
gallstone and requiring surgical removal of your gallbladder. Taking Ursodiol may help
prevent this, but don’t count on it. You need a semi-permanent IV line (PICC line)
placed in your arm by a radiologist. Sometimes, this is worth it. Sometimes not. There
are potential complications and is not to be taken lightly. Another commonly used IV
medicine is Penicillin, 1.2 million units IV 2 to 4 times a day.
As your doctor gets more comfortable with this approach to therapy, she or he
will find that many possibilities open themselves up for using antimicrobial medicines to
treat a seemingly resistant syndrome. he may try different combinations and ways of
dosing the medicines. Pulsing for 4 days out of 7, rotating 2 or 3 RX’s on a weekly or
biweekly basis, keeping some constant, stopping a medicine for a week or two, or other
creative schedules are useful options.
Almost every antibiotic has been tried for this problem. Rifaximin, tetracycline,
itraconazole, ketoconazole, clindamycin, and cephalexin are some choices.
One guiding principle is that side effects are unnecessary and unacceptable. If
you get a minor reaction to starting a new medicine and it only lasts a few days, then that
is okay. I do not believe it is helpful or desirable to have the severe reactions often
described as “Herxing.” For patients who have one of these syndromes of chronic
symptoms (SOCS), the only gauge for the success of treatment is the symptoms. If
symptoms get worse, then the treatment is wrong.
Whichever medicines someone is taking long term, I believe office visits and
examinations should be performed every 8 to 12 weeks. A comprehensive medical
profile – which is blood testing of liver and kidney function, electrolytes, and blood sugar
– must be done every 4 weeks. Although this may be overkill, keep in mind that this is
alternative medicine and monitoring is a safety issue.