However, since the diagnosis of encephalopathy was based on clinical symptoms and serological results, and since end points for improvement were subjective, the objective treatment response of strictly defined Lyme encephalopathy to iv ceftriaxone of 2 or 4 weeks' duration still remains unclear.
Among patients with persistent symptoms, the most common ones were arthralgia, weakness, malaise, or fatigue. It was concluded that 2 g per day of iv ceftriaxone for 2 weeks was equivalent to higher doses and longer courses for the treatment of late Lyme disease.
As Lyme is a slow-growing germ, the spirochete form only requires two to three days for some antibiotics to work and then several days to recover and Lyme to start growing again. All the antibiotics mentioned in this article may be pulse-dosed except for azithromycin.
Because documented Lyme encephalopathy is rare (we see only 2 or 3 such patients per year), the study design was an observational case series of a single antibiotic regimen. Treatment for 4 weeks was selected because previous series, including our own, suggested that relapse may sometimes occur with 2 weeks of therapy.
The mean time from the appearance of erythema migrans to the start of treatment was 9 days in the ceftriaxone group and 10 days in the doxycycline group.
A 14- to 21-day course of antibiotics is usually recommended, but some studies suggest that courses lasting 10 to 14 days are equally effective. Intravenous antibiotics. If the disease involves the central nervous system, your doctor might recommend treatment with an intravenous antibiotic for 14 to 28 days.
Individuals with neurologic Lyme disease, cardiac Lyme disease, or Lyme arthritis that hasn't responded well to oral antibiotic treatment will often be given intravenous ceftriaxone. Ceftriaxone has excellent penetration of the blood-brain barrier and is one of the most effective drugs for Lyme disease.
For early Lyme disease, a short course of oral antibiotics, such as doxycycline or amoxicillin, cures the majority of cases. In more complicated cases, Lyme disease can usually be successfully treated with three to four weeks of antibiotic therapy.
Neurologic conditions associated with late Lyme disease are treated with intravenous antibiotics, usually ceftriaxone or cefotaxime, given daily for two to four weeks.
The bacterial infection can infect the joints, heart, or nervous system if left untreated. However, you may have more time than you think to prevent the disease from gaining a foothold in your body.
Interactions between your drugs No interactions were found between ceftriaxone and doxycycline.
How is Lyme disease treated? For early Lyme disease, a short course of oral antibiotics such as doxycycline or amoxicillin is curative in the majority of the cases. In more complicated cases, Lyme disease can usually be successfully treated with three to four weeks of antibiotic therapy.
Some question chronic illness This is despite the fact that the antibiotic Rocephin alleviates the symptoms of Lyme disease, say many patients who have used it and doctors and nurses who have treated them with it.
Most people who develop Lyme disease recover fully following a course of antibiotics. In rare cases, Lyme disease symptoms may persist for weeks, months, or even years after antibiotic treatment.
In rare cases, you may experience a continuation of Lyme disease symptoms after antibiotic treatment. This is called post-treatment Lyme disease syndrome (PTLDS).
Borrelia burgdorferi, the bacteria that causes Lyme disease. The bacteria that causes Lyme disease can survive in organ tissue after treatment with a full course of antibiotics months after infection, according to a new primate study of the disease by Tulane University researchers.
The 18 patients who met entrance criteria for Lyme encephalopathy (the intention-to-treat group) were treated with iv ceftriaxone, 2 g once a day for 30 days. Treatment was administered at home. During therapy, complete blood cell count and liver function tests were monitored weekly. A follow-up visit was required 6 months after completion of therapy. At that visit, patients were asked to rate their symptoms as worse, unchanged, somewhat improved, greatly improved, or improved to normal compared with their pretreatment state. In addition, neuropsychological tests were repeated, and equivalent but different versions of the CVLT or SRT were used to minimize practice effects. If CSF abnormalities were present initially, the patients were requested to undergo repeated lumbar puncture for CSF analysis. Previous experience had shown that brain MRI did not change after antibiotic treatment [ 3 ], and therefore, follow-up MRI was not done. However, after August 1992, posttreatment SPECT scanning was repeated in all patients. A final assessment was made 12–24 months after treatment either in the clinic or by telephone. Patients were again asked to assess their symptoms, but follow-up testing was not required.
burgdorferi infection. Following 1—month courses of iv ceftriaxone, all but 1 patient experienced gradual, sustained improvement in symptoms. Six months after treatment, the patients tested had significant improvement in verbal or visual memory tests and significantly lower CSF protein levels.
During the study period, 36 patients with previous classical manifestations of Lyme disease and current neuropsychiatric symptoms (see below) were seen at the Lyme Disease Clinic at the New England Medical Center. Of the 36 patients, 18 met the entrance criteria (the intention-to-treat group). Of the 18 patients who did not meet these criteria, 7 lacked objective abnormalities on neuropsychological tests or evidence of past or present B. burgdorferi infection in spinal fluid, 5 had a preexisting illness associated with cognitive impairment, 1 had a history of alcohol abuse, and 5 had already received treatment with ⩾1of IV ceftriaxone.
The most common symptom of Lyme encephalopathy was memory difficulty, usually requiring patients to compensate with new behaviors such as list making, relying on spouses, or making greater efforts to concentrate ( table 2 ). In all 18 patients, family members endorsed the problem with memory. Mild depression, irritability, headache, and somnolence were less common. Of the 18 patients, 5 had a coexistent, predominantly sensory polyneuropathy, manifested in 4 cases as distal paresthesia (e.g., “numbness,” “pins and needles,” or distal “jabbing”), usually in both the hands and feet, and in 1 case as thoracolumbar radicular pain ( table 2 ). All 5 patients with neuropathy had sensory loss to vibration or pinprick in the feet. One patient had muscle weakness and areflexia. All 5 had documented abnormalities on electrophysiologic testing, as previously described [ 19 ].
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 [ 14 ], and positive results were interpreted according to the CDC/ASTPHLD criteria [ 15 ]. 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 [ 9 ]. 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 [ 8 ].
Lyme encephalopathy is a rare neuropsychiatric disorder, predominantly affecting memory and concentration [ 3–7 ]. Other associated symptoms and signs may include headache, mild depression, irritability, fatigue, or excessive daytime sleepiness [ 3 ]. Although the neurological examination does not usually disclose focal neurological findings, and standard bedside memory tests may be unrevealing, there is often objective evidence of memory impairment for verbal and, less commonly, visual information on formal neuropsychological testing [ 3–5 ]. Cerebrospinal fluid (CSF) examination by use of polymerase chain reaction (PCR) may detect B. burgdorferi DNA [ 8 ], local production of antibody to B. burgdorferi [ 9 ], or the less specific finding of elevated protein [ 3 ], or the CSF may be normal [ 3–5 ]. CSF pleocytosis, a frequent finding in early Lyme neurobor reliosis, is rarely found in Lyme encephalopathy. In addition, brain magnetic resonance imaging (MRI), even with gadolinium enhancement, is usually normal, although nonspecific white matter lesions are seen in some patients [ 3–6 ].
Except for 1 patient who experienced 1 relapse, they had sustained improvement after treatment with 2 g of iv ceftriaxone once a day for 30 days. We conclude that Lyme encephalopathy can usually be treated successfully with a 1-month course of ceftriaxone, which suggests that it is caused by active infection with B. burgdorferi.
In a statistical model, the ceftriaxone group showed a slightly greater improvement at 12 weeks, but at 24 weeks both the ceftriaxone and the placebo groups had improved similarly from baseline. In addition, adverse effects attributed to intravenous ceftriaxone occurred in 26 percent of patients.
In more complicated cases, Lyme disease can usually be successfully treated with three to four weeks of antibiotic therapy.
NIAID-supported studies have shown that B. burgdorferi can be detected in mice for at least three months after treatment with therapeutic doses of various antibiotics (ceftriaxone, doxycycline, or azithromycin). In these studies, surviving bacteria could not be transmitted to healthy mice, and some lacked genes associated with infectivity. By six months, antibiotic-treated mice no longer tested positive for the presence of B. burgdorferi, even when their immune systems were suppressed. Nine months after antibiotic treatment, low levels of Borrelia DNA still could be detected in some—but not all—of the mice. These findings indicate that noninfectious B. burgdorferi can persist for a limited period of time after antibiotic therapy. The implications of these findings in terms of persistent infection and the nature of PTLDS in humans still need to be evaluated.
Animal models have provided considerable information on the transmission and pathogenesis of Lyme disease, as well as on the mechanisms involved in the development of protective immunity. Studies of the effects of antibiotic therapy in animals infected with B. burgdorferi have been conducted most often with mice but also with rats, hamsters, gerbils, dogs, and non-human primates.
Patients were treated with 30 days of an intravenous antibiotic followed by 60 days of treatment with an oral antibiotic.
By six months , antibiotic-treated mice no longer tested positive for the presence of B. burgdorferi, even when their immune systems were suppressed. Nine months after antibiotic treatment, low levels of Borrelia DNA still could be detected in some—but not all—of the mice.
The susceptibility of B. burgdorferi, the bacterium that causes Lyme disease, to specific antibiotics
How long to treat patients with Lyme remains an issue of controversy. With traditional antibiotic therapy, lasting 2-4 weeks, 10-20% of patients will have ongoing symptoms including fatigue, joint pain, insomnia and complaints of “brain fog.” Indefinite long-term treatment is advocated by ILADS (International Lyme and Associated Diseases Society), based on a patient’s symptoms. In contrast, IDSA (Infectious Disease Society of America ) only recommends 2-4 weeks' treatment. The two groups are bitter adversaries.
The 280 patients were evaluated for “quality of life” using a standard questionnaire (RAND-36 Health Status Inventory (SF-36)) before treatment, at the end of the treatment period and at follow-ups. The SF-36 assesses physical functioning, role limitations due to health problems, pain and a patient’s perception of their overall health, as well as their fatigue. This questionnaire provides a good overview; some other scales could have provided more detail.
10% of the doxycycline patients had nausea (lower than I would expect) and 19% had photosensitivity.
But Lyme can be difficult to diagnose, and the assays miss a lot of patients (half the patients had negative antibody tests before treatment and 29% never developed antibodies in a recent gene expression study ).
Post-treatment Lyme disease syndrome (PTLDS) is clearly a problem for many patients, but we don’t know what causes it.
No differences were found between the placebo and the two antibiotic treatment groups. Antibiotic therapy was not without complication. Four patients (1.4%) had serious reactions to the ceftriaxone, three of which required hospitalization for hives and respiratory distress. 29% had a rash or allergic reaction.
No differences were found between the placebo and the two antibiotic treatment groups.
The following are four rules to develop a Lyme disease antibiotic regimen.
To get rid of Lyme germs, all forms must be treated at the same time. Rule 2. Combine antibiotics to treat Lyme living outside and inside of cells. Most physicians think Lyme lives outside of cells in tissues that hold cells and body structures together, or even on nerve coverings.
Generally, I suggest rotating a prescription antibiotic every six months to prevent resistance to that antibiotic. However, I find herbal antibiotics work well for a year or more without changing the herbs. Lyme does not easily develop herbal antibiotic resistance.
Recent research shows Lyme can form persisters. These are forms of spirochetes and cysts that slow their metabolism way down. In this hibernation state, they can ignore the antibiotics sent to kill them.
Thus, the majority of people with chronic Lyme do not require IV antibiotics.
However, Miklossy shows that Lyme lives inside cells and outside of cells. (6) To recover from Lyme, it is necessary to treat Lyme germs living inside cells and outside of cells at the same time. Antibiotics that work inside of cells include the tetracyclines, macrolides, rifamycins, and azoles.
Pulsing herbal antibiotics does not work well, therefore, I do not recommend it here. Clinically, continuous use of herbal antibiotics works best in most situations. The only time I pulse is for two months on and two months off when using regimens to address persister Lyme. For more information about this see How to Treat Persister Lyme. What Works? Pay attention to the Burrascano-type regimen I mention.
IDSA, AAN, and ACR Recommendations for Children: 50 to 75 mg/kg IV once a day#N#Maximum dose: 2 g/dose#N#Duration of Therapy:#N#-Carditis: 14 to 21 days#N#-Meningitis or radiculopathy: 14 to 21 days#N#-Recurrent/refrac tory arthritis: 14 days; can extend repeat IV therapy up to 28 days if inflammation not resolving#N#Comments:#N#-Recommended as the initial IV treatment of Lyme carditis in patients requiring hospitalization; therapy can be completed orally after evidence of clinical improvement.#N#-Recommended as the preferred IV agent for patients with Lyme disease-associated meningitis, cranial neuropathy, radiculoneuropathy, or other PNS manifestations#N#-Recommended as IV therapy in patients with Lyme arthritis who had no/minimal response (moderate to severe joint swelling with minimal reduction of joint effusion) to an initial oral regimen#N#-Current guidelines should be consulted for additional information.
Usual Adult Dose for Septicemia. 1 to 2 g IV or IM once a day (or in equally divided doses twice a day) Duration of therapy: 4 to 14 days. -Complicated infections: Longer therapy may be required.
American Heart Association (AHA) and IDSA Recommendations:#N#-Native valve infective endocarditis (NVE) due to highly penicillin-susceptible viridans group streptococci (VGS) or S gallolyticus (bovis): 2 g IV or IM every 24 hours for 4 weeks#N#---When used with gentamicin: 2 g IV or IM every 24 hours for 2 weeks#N#-Prosthetic valve (or other prosthetic material) infection due to VGS or S gallolyticus (bovis): 2 g IV or IM every 24 hours for 6 weeks#N#-NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species by a strain susceptible to penicillin and gentamicin (if able to tolerate beta-lactam therapy): 2 g IV every 12 hours for 6 weeks#N#-NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species by a strain susceptible to penicillin and resistant to aminoglycosides or streptomycin-susceptible gentamicin-resistant (if able to tolerate beta-lactam therapy): 2 g IV every 12 hours for 6 weeks#N#-NVE or prosthetic valve (or other prosthetic material) infection due to HACEK microorganisms: 2 g IV or IM every 24 hours#N#---Duration of therapy: 4 weeks (NVE); 6 weeks (prosthetic valve infection)#N#US CDC Recommendations:#N#-Gonococcal endocarditis: 1 to 2 g IV every 12 to 24 hours for at least 4 weeks#N#Comments:#N#-Recommended for patients with normal renal function#N#-With or without gentamicin, recommended for NVE due to highly penicillin-susceptible VGS or S gallolyticus (bovis)#N#---The 2-week regimen (with gentamicin) is not intended for patients with known cardiac/extracardiac abscess, CrCl less than 20 mL/min, impaired 8th cranial nerve function, or Abiotrophia, Granulicatella, or Gemella species infection.#N#-With or without gentamicin (penicillin-susceptible strain [MIC up to 0.12 mcg/mL]) or with gentamicin (relatively/fully penicillin-resistant strain [MIC greater than 0.12 mcg/mL]), recommended for prosthetic valve (or other prosthetic material) infection due to VGS or S gallolyticus (bovis)#N#-With ampicillin, recommended for NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species by a strain susceptible to penicillin and gentamicin (if able to tolerate beta-lactam therapy)#N#-With ampicillin, recommended for NVE or prosthetic valve (or other prosthetic material) infection due to Enterococcus species by a strain susceptible to penicillin and resistant to aminoglycosides or streptomycin-susceptible gentamicin-resistant (if able to tolerate beta-lactam therapy)#N#-Recommended as preferred therapy for NVE or prosthetic valve (or other prosthetic material) infection due to HACEK microorganisms#N#---HACEK indicates Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species#N#-With azithromycin, recommended regimen for the treatment of gonococcal endocarditis#N#---The patient's sexual partner (s) should also be evaluated/treated.#N#-Current guidelines should be consulted for additional information.
AHA Recommendations:#N#1 year or older: 100 mg/kg/day IV in divided doses every 12 hours OR 80 mg/kg IV every 24 hours#N#Maximum dose: 4 g/day#N#Duration of therapy: At least 4 to 6 weeks#N#US CDC Recommendations for Adolescents:#N#-Gonococcal endocarditis: 1 to 2 g IV every 12 to 24 hours for at least 4 weeks#N#Comments:#N#-Daily dosage should be administered in divided doses twice a day if over 2 g/day.#N#-Recommended regimen (and an alternative regimen) for infective endocarditis due to highly penicillin G-susceptible streptococci (minimum bactericidal concentration [MBC] up to 0.1 mcg/mL)#N#-With ampicillin (for aminoglycoside-resistant enterococci or aminoglycoside-intolerant patient) or gentamicin (not for enterococcal endocarditis), recommended as an alternative regimen for infective endocarditis due to relatively penicillin-resistant streptococci (MBC at least 0.2 mcg/mL)#N#-With gentamicin, recommended regimen for infective endocarditis due to gram-negative enteric bacilli#N#-Recommended regimen for infective endocarditis due to HACEK group#N#---HACEK organisms include Haemophilus species, Aggregatibacter species, C hominis, E corrodens, and Kingella species.#N#-With azithromycin, recommended regimen for the treatment of gonococcal endocarditis in adolescents#N#---The patient's sexual partner (s) should also be evaluated/treated.#N#-Pediatric dose should not exceed adult dose.#N#-Current guidelines should be consulted for additional information.
Usual Adult Dose for Pelvic Inflammatory Disease. 1 to 2 g IV or IM once a day (or in equally divided doses twice a day) Duration of therapy: 4 to 14 days. -Complicated infections: Longer therapy may be required.
Usual Adult Dose for Bronchitis. 1 to 2 g IV or IM once a day (or in equally divided doses twice a day) Duration of therapy: 4 to 14 days. -Complicated infections: Longer therapy may be required.
-Complicated infections: Longer therapy may be required. -Infections due to Streptococcus pyogenes: At least 10 days. Comments:
Ceftriaxone is typically given once a day intravenously, typically in 45 minutes.
Ceftriaxone has excellent penetration of the blood-brain barrier and is one of the most effective drugs for Lyme disease. Ceftriaxone is typically given once a day intravenously, typically in 45 minutes. While this can be administered in the doctor’s office on a daily basis through a peripheral vein, most commonly it is administered through a mid-line or a PICC line that once inserted can be accessed for the daily infusions at home (thereby eliminating the discomfort and inconvenience of daily needle sticks).
Amoxicillin is a broad spectrum bacteriocidal antibiotic that works by inhibiting cell wall synthesis. Amoxicillin can be taken with or without food. This 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. Amoxicillin is often prescribed to children under age 8 and to pregnant women who get Lyme disease. Augmentin is a combination medication that includes both amoxicillin and the enzyme inhibitor clavulanate that allows the amoxicillin to be more effective against other penicillin-resistant microbes; a downside of this combination is that it might cause signfiicantly more gastrointestinal disturbance than plain amoxicillin. Most studies have found plain amoxicillin to be highly effective against Borrelia burgdorferi and thus the combination (Augmentin) is not needed.
Cefuroxime, a bacteriocidal 2nd generation cephalosporin, is FDA approved for the treatment of early Lyme disease. Cefuroxime works by disrupting cell wall synthesis and does cross the blood brain barrier to some extent. (The term “generation” when applied to cephalosporins simply refers to when the drug was developed and generally means that the “later” generation versions have a longer half-life (so they don’t need to be taken as frequently) and have better efficacy and safety.) Cefuroxime should be taken with food in twice daily dosing.
Doxycycline is considered the first-line drug of choice for Lyme disease by most physicians. Doxycycline, a bacteriostatic antibiotic, has the advantage of twice daily dosing and effectiveness not only for Lyme disease but also for some other tick-borne diseases such as borrelia miyamotoi disease, ehrlichiosis, anaplasmosis, tularemia, and rocky-mountain spotted fever. In Europe, doxycycline is considered to have comparable efficacy for neurologic Lyme disease as intravenous ceftriaxone; this has not yet been examined in the United States however and may not apply to U.S. neurologic Lyme disease as the genospecies causing neurologic Lyme in the US is B.burgdorferi while in Europe it is most commonly caused by B.garinii. Doxycycline absorption is decreased by food and milk and especially decreased by antacids or laxatives that contain calcium, magnesium, or aluminum or vitamins that contain iron. The latter medications or vitamins should be taken 6 hours before or 2 hours after the dox cycline.
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.
Note 1: Doxycycline raises the risk of sunburns due to increased skin sensitivity to sunlight. Doxycycline side effects include moderate to severe gastric symptoms (nausea, vomiting, diarrhea), vaginal yeast infections, decreased effectiveness of birth control pills, and rarely liver damage or esophagitis. Doxycycline should not be combined with the acne drug isotretinoin as that will increase the risk of elevated intracranial pressure (and the potential for vision loss).
In a small percentage of cases, symptoms such as fatigue (being tired) and myalgia (muscle aches) can last for more than 6 months. This condition is known as post-treatment Lyme disease syndrome (PTLDS), although it is also sometimes called chronic Lyme disease.
Lyme arthritis. The National Institutes of Health (NIH) 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.
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 person’s age, medical history, underlying health conditions, pregnancy status, or allergies. Consult an infectious disease specialist regarding individual patient treatment decisions.
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: Neurologic Lyme disease. Lyme carditis.
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.
The. Most common IV antibiotic used in Lyme disease treatments is Ceftriaxone, or more commonly known as Rocephin. IV antibiotics will usually be prescribed when a patient is very sick and needs more immediate relief or a greater, more aggressive and systemic way of attacking the bad bacteria. Depending on your doctor and what type ...
Due to the strong nature of IV antibiotics, pulsing throughout the week is a common form of treatment. Example: 4 days on, 3 days off. Each infusion will take anywhere from 30 minutes to an hour and a half and can be done at your own home either on your own (assuming you’ve been trained by your Doctor) or via a visiting nurse. Otherwise, infusions will be done at a hospital infusion lab or doctor’s office.
The major difference between IV and oral antibiotics is that oral antibiotics must travel through the digestive system before they can be fully absorbed into the blood while IV antibiotics are administered directly into the blood. The. Most common IV antibiotic used in Lyme disease treatments is Ceftriaxone, or more commonly known as Rocephin.
Also like the PICC line, a Port can stay in for several weeks to several months without needing to be changed or taken out.
IV Antibiotics for Lyme disease: IV Antibiotics for Lyme disease. : IV therapy is when liquid substances (ie. Meyers cocktail, or Ceftriaxone) are delivered to the body via a vein in the arm, back of the hand, port or other methods. This system of delivery allows for the liquid to be directly infused into the blood, ...
Each infusion will take anywhere from 30 minutes to an hour and a half and can be done at your own home either on your own (assuming you’ve been trained by your Doctor) or via a visiting nurse. Otherwise, infusions will be done at a hospital infusion lab or doctor’s office.
CONS: Can be expensive if not covered by insurance. Can be painful of uncomfortable, especially at first. Will likely need a Lyme literate doctor to prescribe these. Herx reactions (see Combinations Pulsed Antibiotics for more information) may come on quicker than usual and be more intense. As with all antibiotics, symptoms can range from manageable to severe.