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natural medicines: Otoba Bark Extract., Unicaria tomentosa commonly called Cat's Claw, grapefruit seed extract
prescription medicines: benzathine penicillin G (bicillin LA) , amoxicillin, amoxicillin/clavulanic acid (Augmentin), cefuroxime (Ceftin), cefdinir (Omnicef), ceftriaxone (Rocephin), ceftazidime (Zinacef), azithromycin (Zithromax), clarithromycin (Biaxin), doxycycline, minocycline, tetracycline, metronidazole (flagyl), tinidazole (tindamax), rifampin
Treating borrelia, the Lyme germ, with antibiotics is complicated. There is limited research showing which treatment regimens work best. So many Lyme Literate Medical Doctors (including me) prescribe antibiotics based on a theory and our collective observation that combinations of antimicrobials work better than single agents alone. What follows is not definitive or comprehensive guide. Rather it reflects how I organize and put together my effective Lyme disease treatments.
There are four rules I use in developing an antibiotic regimen.
- Combine antibiotics to treat all forms of the germ. Borrelia may exist in three separate forms. These forms are the spirochete, a cell-wall deficient form also called the L-form, and a cyst form. Some question if the L-form and the cyst form are the same. It is possible that borrelia can change itself from one form to another form. For instance, under the stress of an antibiotic treatment, the spirochete can convert to a more treatment resistant cyst form of the germ. At any one time, it is likely that a person with chronic Lyme disease has borrelia existing in all forms.
- Combine antibiotics that work differently to attack the germ from different angles. Families of antibiotics work differently. For instance the penicillins and cephalosporins (see below) work to weaken the outer covering of the spirochete while the tetracylines and the macrolides limit the ability of the spirochete and l-form to grow by blocking protein production.
- Work with no more than three antibiotics at a time. As much as possible, I follow this rule to limit toxicity and adverse drug interactions.
- Recovering from chronic Lyme requires more than antibiotics. I cannot emphasize this point enough. It is critical that your recovery address the steps outlined in our Lyme disease treatment guidelines The Successful Treatment Recipe. These steps are designed to resuscitate and to support you and your immune system. Even a year or more into your treatment these steps are essential.
See section IV. Special Considerations below for information about:
- Pulse Dosing,
- IV versus Oral Antibiotics,
- IV Equivalent Treatments,
- Treatment Length,
- Remission, and
- Herxheimer Die-off Reactions.
Questions? Just Ask Us.
Read this article first to see if it answers your questions about using antimicrobials to kill Lyme germs. But if you still have questions join me in our Lyme Q & A webinar Conversations with Marty Ross MD.
II. ANTIBIOTICS I ROUTINELY USE
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- Types: benzathine penecillin G (Bicillin LA), amoxacillin, amoxacillin/clavulanic Acid (Augmentin).
- Germ Forms Treated: The spirochete and possibly the cyst.
- Mechanism: Works by limiting the growth of the cell wall matrix. This results in the covering of the spirochete breaking down. Eventually due to pressure inside, the germ bursts through its weakened cell wall and dies. It is not clear how penicillins treat cyst but research by Eva Sapi PhD in the lab shows that amoxacillin does.
- Available As: Prescription medicine.
III. ANTIBIOTIC COMBINATION EXAMPLES
(Here is a sample combination. Subscribe below to see the 10 different examples.)
2. Macrolide plus Quinine Derivative plus Azole
- azithromycin (Zithromax) 500mg 1 time a day, hydroxychloroquine (Plaquenil) 200mg 2 times a day, and metronidazole (flagyl) 500mg 2 or 3 times a day.
Key Point: Hydroxychloroquine is used to increase the effectiveness of azithromycin which is generally not as effective as other macrolides like clarithromycin.
Key Point: Tinidazole could be substituted for the metronidazole because it may remove biofilms more effectively.