James L. Schaller, M.D.  •  239-263-0133

How Long Should One Treat Lyme Disease?

I believe each physician should have the right to look at the thousands of articles on this infection, such as this one on tigecycline, like no guideline writer could possibly do, and should be free to treat short, moderately or long. It is a decision between the physician and the patient, and this obvious position took years to become accepted by the New York State board of medicine after torturing many physicians struggling with this nasty infection. Indeed, an infection that I feel usually does not exist alone in people, particularly with two-three deer tick bites.

This article below is one that supports a longer type treatment. It does not mention Babesia or Bartonella or other deer tick infections, but it reports a solid dose of a very strong antibiotic clearly failed. Other physicians quote effective short treatment articles and feel all Lyme is killed in weeks of treatment. Most physicians and specifically authors of a wide range of guideline positions on "Lyme alone" infections seem to agree treatment should be very fast.

Ineffectiveness of tigecycline against persistent Borrelia burgdorferi [Lyme disease bacteria].

The effectiveness of a new first-in-class antibiotic, tigecycline (glycylcycline), was evaluated during the early dissemination (1 week), early immune (3 weeks), or late persistent (4 months) phases of Borrelia burgdorferi infection in C3H mice. Mice were treated with high or low doses of tigecycline, saline (negative-effect controls), or a previously published regimen of ceftriaxone (positive-effect controls). Infection status was assessed at 3 months after treatment by culture, quantitative ospA real-time PCR, and subcutaneous transplantation of joint and heart tissue into SCID mice. Tissues from all saline-treated mice were culture and ospA PCR positive, tissues from all antibiotic-treated mice were culture negative, and some of the tissues from most of the mice treated with antibiotics were ospA PCR positive, although the DNA marker load was markedly decreased compared to that in saline-treated mice. Antibiotic treatment during the early stage of infection appeared to be more effective than treatment that began during later stages of infection. The viability of noncultivable spirochetes in antibiotic-treated mice (demonstrable by PCR) was confirmed by transplantation of tissue allografts from treated mice into SCID mice, with dissemination of spirochetal DNA to multiple recipient tissues, and by xenodiagnosis, including acquisition by ticks, transmission by ticks to SCID mice, and survival through molting into nymphs and then into adults. Furthermore, PCR-positive heart base tissue from antibiotic-treated mice revealed RNA transcription of several B. burgdorferi genes. These results extended previous studies with ceftriaxone, indicating that antibiotic treatment is unable to clear persisting spirochetes, which remain viable and infectious, but are nondividing or slowly dividing.

Antimicrob Agents Chemother. 2010 Feb;54(2):643-51. Epub 2009 Dec 7.

Barthold SW, Hodzic E, Imai DM, Feng S, Yang X, Luft BJ.