A Lyme Disease Antibiotic Guide

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Herbal and Prescription Antibiotics for Lyme Image from Marty Ross MD

Herbal & Prescription Lyme Disease Antibiotics

"I updated this article on August 6th, 2018 based on the latest. If you read it before, you will find many additions and improvements." 

Marty Ross MD

Learn how to build a Lyme disease herbal or prescription antibiotic treatment. A person with Lyme can use this guide to develop an herbal antibiotic regimen, or to work with a physician to create a successful prescription Lyme disease antibiotic treatment. Later, in this guide, I provide eleven sample herbal and prescription antibiotic treatment plans, including the dosing regimens, I find effective.

Be aware, chronic Lyme disease recovery requires more than antibiotics.

I cannot emphasize this point strongly enough. It is critical that a Lyme disease treatment includes the first ten steps outlined in my Lyme disease treatment guidelines, The Ross Lyme Support Protocol. These steps are designed to revive health and to boost the immune system. Even a year or more into treatment these steps are essential.

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, like me, prescribe antibiotics based on theory, and our collective observation, that combinations of antimicrobials work better than single agents alone. What follows is not a complete or comprehensive guide. Rather, it reflects how I organize and put together my effective Lyme disease antibiotic treatments.

This article focuses on treating borellia (Lyme) only. For my herbal and prescription antibiotic guides for the Lyme disease coinfections see: Kills Bartonella: A Brief Guide, Kills Babesia: A Brief Guide, and Kills Anaplasma and Ehrlichia: A Brief Guide

I. Lyme Disease Antibiotics Overview

There are four rules I use in developing a Lyme disease antibiotic regimen.

Rule 1. Combine antibiotics to treat all forms of the germ.

Borrelia exists in two separate forms. These forms are the spirochete and a cell-wall deficient form that goes by a number of names including round body, L-form, and cyst. In this article I refer to the non-spirochete form as the cyst. The spirochete is the form many know from pictures. It looks like a spiral or a coiled snake.

Under stress borrelia changes itself from one form to another. For instance, when the spirochete is exposed to doxycycline, it 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 both forms.

Rule 2. Combine antibiotics to treat Lyme living outside and inside of cells.

As Miklossy shows, Lyme lives inside cells and outside of cells. This is controversial, as most doctors hold to the idea that Lyme only lives outside of cells in tissues that hold cells and body structures together, or even on nerve coverings. Antibiotics that work inside of cells include the tetracyclines, macrolides, rifamycins, and azoles.

While herbal antibiotics may work inside of cells, it is not clear from research that they do. However, I have seen wonderful recoveries for many on herbal antibiotics, so I assume the ones I recommend in this article help with intracellular Lyme.

Rule 3. 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 tetracyclines and the macrolides limit the ability of the spirochete and l-form to grow by blocking protein production.

Rule 4. Work with no more than three herbal or prescription antibiotic products at a time.

As much as possible, I follow this rule to limit toxicity and adverse interactions.

Special Considerations

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.

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 my Lyme Q&A webinar: Conversations with Marty Ross MD.

II.  LYME DISEASE ANTIBIOTICS I ROUTINELY USE

(Note: This is not a comprehensive list of all antibiotics that can be used.)

Penicillins.

  • Types: benzathine penicillin G (Bicillin LA), amoxicillin, amoxicillin/clavulanic Acid (Augmentin).
  • Germ Forms Treated: The spirochete and possibly the cyst.
  • Location: Outside of cells.
  • 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 amoxicillin does.
  • Available As: Prescription medicine.

Cephalosporins.

  • Types: ceftriaxone (Rocephin) 2gm, ceftazidime (Zinacef), cefuroxime (Ceftin), cefdinir (Omnicef)
  • Germ Forms Treated: The spirochete and possibly cyst.
  • Location: Outside of cells.
  • Mechanism: Same as penicillins.
  • Available As: Prescription medicine.

Tetracyclines.

  • Types: doxycycline, minocycline, tetracycline
  • Germ Forms Treated: The spirochete.
  • Location: Lyme living inside and outside of cells.
  • Mechanism: Blocks protein production at a part of the cell called the 30s ribosome. Ribosomes are located inside of cells where they use genetic programming and amino acids to produce proteins. When protein production is blocked germ growth is limited leading to eventual death.
  • Available As: Prescription medicine

Macrolides.

  • Types: azithromycin (Zithromax), clarithromycin (Biaxin), clarithromycin extended release (Biaxin LA)
  • Germ Forms Treated: The spirochete.
  • Location:  Lyme living inside and outside of cells.
  • Mechanism: Blocks protein production at a part of the cell called the 50s ribosome. Ribosomes are located inside of cells where they use genetic programming and amino acids to produce proteins. When protein production is blocked germ growth is limited leading to eventual death.
  • Available As: Prescription medicine.

Azoles.

  • Types: metronidazole (Flagyl), tinidazole (Tindamax)
  • Germ Forms Treated: Spirochete and cyst.
  • Location: Lyme living inside and outside of cells.
  • Mechanism: Impairs bacterial enzymes and destabilizes dna.
  • Available As: Prescription medicine.

Rifamycins.

  • Types: rifampin and rifabutin
  • Germ Forms Treated: Spirochete and cyst.
  • Location: Lyme living inside and outside of cells.
  • Mechanism: Prevents production of rna from the cell dna. Without rna the bacteria cannot make protein. When protein production is blocked germ growth is limited leading to eventual death.
  • Available As: Prescription medicine

Sulfa Antibiotics

Quinine Derivatives.

  • Types: hydroxychloroquine (Plaquenil)
  • Germ Forms Treated: None. Conflicting research shows could kill cyst or promote cyst growth.
  • Location: Inside of cells.
  • Other Action: Improves effectiveness of macrolides and tetracyclines.
  • Mechanism: Lowers acid levels inside of cell vacuoles where germs can live. Lowering acid levels can help antibiotics work better.
  • Available As: Prescription medicine.

Grapefruit Seed Extract.

  • Types: various supplement brands
  • Germ Forms Treated: Cyst.
  • Location: Unclear from research.
  • Mechanism: Unclear.
  • Available As: Natural medicine.

Herbal Combination Option 1.

  • Types: Otoba Bark Extract (Otoba parvifolia) used with Cat’s Claw (Uncaria tomentosa). See Otoba Bark Extract and Cat’s Claw Tinctures for more information.
  • Germ Forms Treated: Spirochete and cyst.
  • Location: Unclear from research.
  • Mechanism: Unclear.
  • Available As: Natural medicine.

Herbal Combination Option 2.

  • Types: A combination called Biocidin LSF composed of Bilberry extract (25% anthocyanosides), Noni, Milk Thistle, Echinacea (purpurea & angustifolia), Goldenseal, Shiitake, White Willow (bark), Garlic, Grape Seed extract (min 90% polyphenols), Black Walnut (hull and leaf), Raspberry, Fumitory, Gentian, Tea Tree oil, Galbanum oil, Lavender oil (plant and flower), Oregano oil (plant and flower). See Biocidin: A Potent Antimicrobial & Biofilm Breaker for more information about these herbs used in combination.
  • Germ Forms Treated: Spirochete and cyst.
  • Location: Lyme living inside and outside of cells.
  • Mechanism: Echinacea, goldenseal, gentian, and shiitake mushroom found in Biocidin are bacteriostatic and limit the ability of Lyme to grow. Volatile oils like lavender, oregano, and tea tree are bactericidal and kill germs outright. Bilberry, black walnut, garlic, gentian, grape seed, olive leaf, and shiitake mushrooms are also bactericidal.
  • Available As: Natural medicine.

III. LYME DISEASE ANTIBIOTIC COMBINATION EXAMPLES

Persister Lyme

For information about treating persister Lyme, including antibiotic combinations I recommend, see my article How to Treat Persister Lyme. What Works? I am not including sample antibiotic combinations for treating persister Lyme in this section because I cover them in the Lyme persister article. Persister regimens can include the Sulfa antibiotics I mentioned above.

Note, as I write this article in August, 2018, it is too early to tell if the new focus on treating persisters in Lyme will or will not help most people. As such, I recommend initially using the combinations below for six or more months to see if they will work.

The Lyme Disease Antibiotic Herbal and Prescription Combinations

This is a very limited list. There are many possible combinations. These are combinations I have tried and find very effective.

In my practice, I find the prescription antibiotic combinations below work 85 to 90% of the time. The combination of otoba bark and cat's claw also works 85 to 90% of the time. The Biocidin LSF works around 70 to 75% of the time. I find all of these combinations more succesful than the Buhner andrographis/Japanese knotweed/cat’s claw combinations which help about 60 to 65% of the time. To reach the success rates I describe here it is essential to follow the first ten steps of The Ross Lyme Support Protocol to boost the immune system. 

Key Points: Each combination

  • Treats all Lyme germ forms.
  • Attacks the germ from different angles through different mechanisms of action.
  • Works inside and outside of cells.

1.  Macrolide plus Azole

Clarithromycin (Biaxin) 500 mg 2 times a day and tinidazole 500 mg 2 or 3 times a day.

Key Point: Tinidazole can remove biofilms that block the immune system and antibiotics. (See Biofilms: Lyme Disease Gated Communities on this site for more information about biofilms and treatments.)

2.  Macrolide plus Quinine Derivative plus Azole

Azithromycin (Zithromax) 500 mg 1 time a day, hydroxychloroquine (Plaquenil) 200 mg 2 times a day, and metronidazole (flagyl) 500 mg 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.

3.  Macrolide plus Grapefruit Seed Extract

Clarithromycin (Biaxin) 500 mg 2 times a day and grapefruit seed extract 250 mg 2 times a day.

Key Point: Grapefruit seed extract is better tolerated than tinidazole and metronidazole and is fairly effective as an anti-cyst agent.

4. Tetracycline plus Macrolide plus Grapefruit Seed Extract

Doxycycline 100 mg 2 pills 2 times a day, clarithromycin (Biaxin) 500 mg 2 times a day, and grapefruit seed extract 250 mg 2 times a day.

Key Point: Tetracyclines and macrolides both block protein production by binding to the protein production apparatus in germs called ribosomes. But they each bind to a different part of the ribosome improving the blockade of protein production.

5. Penicillin plus Azole

Amoxicillin 500 mg 4 pills 3 times a day plus tinidazole (Tindamax) 500 mg 3 pills 2 times a day for 4 days on and 3 days off of each 7 days.

Key Point: This is a very high dose of Amoxicillin which is 4 times stronger than physicians prescribe for other infections like ear infections. I consider this dose to be nearly as effective as IV antibiotics (see IV Equivalent Treatments below.)

Key Point: This is a pulse dose regimen of the tinidazole. It may be more effective than continuous regimens (see Pulse Dosing below.)

6. Cephalosporin plus Tetracycline plus Azole

Cefuroxime (Ceftin) 500 mg 2 pills 2 times a day, minocycline 100 mg 1 pill 2 times a day, and Flagyl 500 mg 2 to 3 times a day for 2 weeks on and 2 weeks off of each 4 weeks.

Key Point: Some experts suggest a tetracycline or macrolide in combination with a cephalosporin or penicillin could limit effectiveness. In theory cephalosporins and penicillins work best with rapid germ growth, but the tetracyclines and macrolides limit germ growth. I understand the theory, but in some I find this to be a very effective combination.

7.  Herbal Combinations 1

Otoba Bark Extract plus Cat’s Claw. Start at 5 drops of each 2 times a day and increase every other day by 1 drop per dose until taking 30 drops of each 2 times a day. If you get worse on increasing do not increase until the worsening improves. Take without food (do not have beginning 30 min before food through 2 hours after food but can take with medicines and supplements).

Key Point: I find this combination to be as effective as oral prescription antibiotic combinations. It works successfully about 85 to 90% of the time.

Key Point: In addition to treating all three forms of the germ, this combination removes biofilms.

8. Herbal Combinations 2

Biocidin LSF. Start at 1 pump under the tongue 1 time a day. Every 2 days increase by 1 pump first as 1 pump 2 times a day, then 1 pump 3 times a day, and eventually to 2 pumps 3 times a day. If you develop a herxheimer die-off reaction do not increase until it passes. For sensitive people place 1 pump in 5 ounces of water. Start with 1 ounce 1 time a day. Increase by 1 ounce a day increasing gradually at first to 1 ounce 3 times a day. Eventually, as tolerated, work up to 10 ounces (2 pumps) 3 times a day.

Key Point: I find this combination works successfully about 70 to 75% of the time as a standalone medicine. I use it as an herbal alternative if the otoba bark and cat’s claw combination do not work. I prefer this combination to the andrographis/Japanese knotweed/cat’s claw combinations recommended by Buhner.

Key Point: In addition to treating all three forms of the germ, this combination removes biofilms. It also blocks efflux pumps Lyme uses to remove herbal and prescription antibiotics form the inside.

Key Point: This product is useful in prescription antibiotic combinations because it removes biofilms and blocks efflux pumps that Lyme uses to get rid of antibiotics.

9.  Tetracycline with Rifamycin

Minocycline 100 mg 2 times a day plus rifampin 300 mg 2 pills 1 time a day.

Key Point: This is also an effective regimen for treating a bartonella co-infection. Co-infections are other germs passed on during a tick bite. If someone has a coinfection when possible I choose antibiotic combinations that treat Lyme germs and the coinfection germs.

10.  IV Antibiotic Regimen: Cephalosporin and Azole

Ceftriaxone (Rocephin) 2 gm IV 2 times a day for 4 days on and 3 days off plus tinidazole 500mg taken orally 1 pill 2-3 times a day for 4 days on and 3 days off of each 7 days.

Key Point: Various antibiotics can be used as IV. I use this one most commonly because it is the easiest to administer and one of the lowest cost IV regimens. The ceftriaxone is given in a syringe and injected over 10 min. This is also a pulse dose regimen (see below under Special Considerations). Ceftriaxone could be given daily instead as 2gm IV 1 time a day.

Key Point: I have found various pulse dose regimens of tinidazole to work. These include used as 2 weeks on and 2 weeks off or in the regimen seen here.

11. IV Antibiotic Regimen: Macrolide and Grapefruit Seed Extract

Azithromycin 500 mg IV plus grapefruit seed extract 250 mg orally 2 times a day.

Key Point: azithromycin works quite well as an IV antibiotic but is much weaker in oral form.

IV. SPECIAL CONSIDERATIONS FOR LYME DISEASE ANTIBIOTICS

1.  Antibiotics Alone Are Unlikely to Get You Well.

This is the second time I am making this point because it is very important. It is essential to your recovery that at a minimum your treatment address the steps outlined in my Lyme disease treatment guidelines: The Ross Lyme Support Protocol. Even a year or more into your treatment these 10 steps are essential to resuscitate and to support you and your immune system.

2.  Pulse Dosing.

Pulsing herbal antibiotics does not work well. Therefore, I do not recommend it here. Clinically, continuous use of herbal antibiotics worse best in most situations. The only time I pulse is for 2 months on and 2 month off regimens to address persister Lyme. For more information about this see How to Treat Persister Lyme. What Works? Pay attention to the Burascanno type regimen I mention.

Some prescription antibiotics can be given using pulse dosing. The idea is to start and stop the antibiotics. This allows the body to recover from the toxicity of some of the drugs while providing effective killing of the germ using high doses. Pulsing may also help with persister cells. Lyme is a slow growing germ. The spirochete form only requires 2-3 days for some antibiotics to work and days to recover and to start growing again. All of the antibiotics mentioned in this article can be pulse dosed except for azithromycin. One way to pulse is to use 4 day on and 3 day off regimens. Many physicians have different ways of pulsing antibiotics.

3.  IV Versus Oral Antibiotics.

In my experience I find most oral antibiotic combinations to work around 85% of the time while IV equivalent treatments work around 90% of the time. Thus the majority of people with chronic Lyme do not require IV antibiotics.

4.  IV Equivalent Treatments.

I find that benzathine penicillin G (Bicillin LA) 1.2 million units given 3 to 4 times a week or high dose oral amoxicillin 500mg 3-4 pills 3 times a day is nearly as effective as IV antibiotic regimens. These treatment regimens deliver effective drug levels that penetrate tissues and the brain.

5.  Treatment Length.

Continue treatment with antibiotics until you are well. For some, this may mean complete recovery, for others, not. It is hard to predict at the beginning of a treatment for someone with chronic Lyme what the degree of recovery. For more information about this see Getting Healthy: Will I? When? How Do I?

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.

It is time to stop a full treatment when someone is either symptom free for 2 months or the improvements are plateaued for four months with no improvements seen after adjustments in the regimen. On average it can take two years to recover for someone with chronic Lyme. This is an average. Some are on the six month program, while others may require years.

Follow the steps in Can’t Get Better? Do This at Treat Lyme to see what else to address if antibiotics are not working, or if you are at a plateau.

6.  Remission.

For some with chronic Lyme disease, a cure does not occur. Refer to Finished? And How To Prevent Relapse. for a discussion of this.

7.  Herxheimer Die-off Reaction.

About 90% of the time when antibiotics are started or changed during a treatment, a person will initially worsen. This is often due to a herxheimer die-off reaction. Refer to Herxheimer Die-off Reaction: Inflammation Run Amok for a discussion of this and practical steps you can take to prevent or treat it.

References

  1. Buhner SH. Healing Lyme: Natural Healing of Lyme Borreliosis and the Coinfections Chlamydia and Spotted Fever Rickettsioses. 2nd ed. Silver City, NM: Raven Press; 2015.
  2. Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guidelines recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti-Infect Ther. 2014;12:1103–1135. doi: 10.1586/14787210.2014.940900.
  3. Datar A, Kaur N, Patel S, Luecke D, Sapi E. In vitro effectiveness of samento and banderol herbal extracts on the different morphological forms of Borrelia burgdorferi. Townsend Lett 2010;7: 1–4.
  4. Gilbert L. Analysis of the activity of Biocidin compounds against borrelia. Unpublished presentation from 2016 of research conducted by Dr. Gilbert’s lab in Finland provided through personal communication from Rachel Fresco LAc PhD.
  5. Goc A, Rath M. The anti-borreliae efficacy of phytochemicals and micronutrients: an update. Therapeutic Advances in Infectious Disease. 2016;3(3-4):75-82. doi:10.1177/2049936116655502
  6. Miklossy J, Kasas S, Zurn AD, McCall S, Yu S, McGeer PL. Persisting atypical and cystic forms of Borrelia burgdorferi and local inflammation in Lyme neuroborreliosis. J Neuroinflammation. 2008;5:40.
  7. Sapi E, Kaur N, Ananwu S, Luecke DF, Luecke DF, Datar A, Patel S, Rossi M, Stricker RB. Evaluation of in-vitro antibiotic susceptibility of different morphological forms of Borrelia burgdoferi. Infect Drug Resist. 2011;4:97–113.

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