Recently I was contacted and interviewed by a party to get my feelings about the state of treatment of Lyme disease. On the phone we lamented about the sizable number of poor souls who continue to suffer symptoms after what is considered standard of care treatment. I made it clear to the interviewer that I practice only evidence-based medicine and that I treat patients based upon the IDSA guidelines. I also railed against physicians who treat patients with months of parenteral antibiotic therapy for “Chronic Limes’ Disease” (ha ha). I stated fairly aggressive and believe that such practices opens the patient to life threatening infections including catheter-related bacteremia and Clostridium difficile colitis.
After I got off the phone I started to do some soul searching. I have gotten so used to saying the same lines over and over again, but when was the last time that I actually had looked at the literature? The answer obviously was way too long ago. I was able to identify 5 clinical trials of prolonged versus standard treatment durations for Lyme disease. None of these studies suggested any benefit from prolonged treatment that would lead me to change my current practice. I could not find definitive data for or against persisting infection in animals or humans after treatment.
This is where things started to unravel in my review of the literature. Papers in the literature describe Borrelia existing in 3 many forms; spirochetal, round bodies and in biofilms. The typical drugs used in treatment including Doxycycline, Amoxicillin, Cefuroxime and Ceftriaxone are active against the actively dividing spirochetal form but have little activity against the other forms. Interestingly all the prolonged treatment trials involved Ceftriaxone and/or Doxycycline. Agents in vitro that have activity in biofilms include Daptomycin, Tinidazole and even the artificial sweetener Stevia. The combination of Doxycycline, Cefuroxime and Daptomycin and Stevia monotherapy were effective in vitro against all Borrelia forms. This data opened my mind to the fact that maybe we are not done with clinical trials of treatments for Lyme disease. I would consider a clinical trial of 2 weeks of Doxycycline vs. 2 weeks Doxy+ Cefuroxime + Daptomycin and a trial of 2 weeks of Doxy with or without a formulation of Stevia.
LOL. Funny article. Lets keep daptomycine a reserve antibiotic. BTW. If persisters really turn out to be the tissue disulfiram will treat it. See Lewis study. Much safer and not used in infectious disease medicine.
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ReplyDeleteSo let me get this straight. You openly admit that studies show that the lyme bacteria can evade long term antibiotics... and that cyst and biofilm forms of Lyme Persist.. but you deny chronic Lyme or post treatment Lyme disease exists (even though this sharply conflicts with readily available peer review studies). Further, you’ve stated you support the new proposed IDSA recommendations even though they don’t even mention the same variations of Lyme you mention here including cyst form, cell wall deficient and biofilm. The recommendations also make no recommendations for neuro lyme. As a infectious disease doc, how can you support guidelines that are overtly incomplete starting with your very own blog comments?