Fifth Installment: Summary of Treatment Guidelines

This section is nearly impossible to summarize. I cannot do justice to the depth and breadth of Dr. Burrascano’s work on the subject. All I can do is to present some of the sweeping principles and urge you to read his work directly if you are interested in the very details of this complex subject. Go to: http://www.lymenet.org/drbguide200509.pdf and you will find his entire abstract.

I offer the following light summary:

Some Principles:

• Contrary to early thinking, Dr. Burascanno reports that the bacteria from a tick infected with the Lyme spirochete travels within the nervous system as soon as twelve hours after entering the blood stream! This is why immediate treatment is critical; full dose antibiotics therapy with the right agent is needed to penetrate all tissues in concentrations known to kill the bacteria in the human body.

• Point two: It follows that “the longer a patient had been ill with Lyme Borellia prior to first definitive therapy, the longer duration of treatment must be, and the need for more aggressive treatment increases.”

• Third point: Using immunosuppressants including steroids with an active infection can cause serious, permanent damage! The immune system is already damaged, and this treatment is dangerous.

• Four: Treatment resistance can occur which reduces the success of antibiotic treatment. Some strains of Borrelia burgdorferi actually contains enzymes which undermine the effect of antibiotics such as cephalosporins and penicillins. Longer and stronger doses and treatment with different agents are sometimes necessary in what is now called “treatment resistant Lyme disease.“ This is especially true in some heart conditions which reoccur even after treatment.

• B. burgdorferi can cross the placenta and infect the fetus. In addition, breast milk from infected mothers has been shown to harbor spirochetes that can be detected by PCR. Treatment is recommended for pregnant mothers.

• Safety: Long term use of antibiotics has been used for many years for conditions such as rheumatic fever, acne, gingivitis, recurrent otitis,recurrent cystitis, and many other conditions. Treatments have not revealed any consistent dire consequences as a result of such medication use. In terms of the treatment of Lyme disease the very real consequences of untreated, chronic perisistnat infection can be far worse than the potential consequenses of this treatment.

Why do some patients fail to get rid of the disease even after extended treatment?

Here are some clues as to why:

• The Lyme bacteria (Bb) can be found both in the fluid and what is called the tissue compartments. Different types of antibiotics are needed to address this problem.

• The Lyme bacteria (Bb) can actually penetrate individual cells. What that means is that different antibiotics are needed for inside and outside the cells.

• Shapeshifting: this is what the Lyme bacteria seem to do. Like in Star Trek, the Shapeshifter stymies its enemies. The spirochete morphs into a spheroplast (also called an I-form); it then does it’s magic again when it shifts into cystic form. It appears from some recent research that “Bb can shift among the three forms during the course of the infection”. Each form requires different treatment agents. When in cyst form it seems to be able to remain dormant; most treatment agents prescribed for Lyme disease do not penetrate into the cyst. Only two medicines seem to knock off the cyst (metronidazole and tinidazole). This is the equivalent of kryptonite to Superman.

• Spirochetes have a very long generation time (12 – 24 hours in vitro and longer in living systems, and may have periods of dormancy during which time antibiotics will not kill the organism! If treatment is discontinued before the infection is cleared, it may cause relapse!

• Thanks to Dr. Shoemaker, we know that there is such a thing as Borrelia Neurotoxin! Two research groups have identified that the Lyme bacteria actually produce a toxic substance that effects neural pathways, and therefore effect how our brains function. These compounds cause ongoing inflammatory reactions and they block hormone action. Only indirect methods have been developed to test for the presence of neurotoxins: cytokine activation and hormone resistance can be measured as well as a “visual contrast sensitivity test” can be helpful in documenting the effects of the neurotoxin in the Central Nervous System. The longer you are sick with Lyme, the more neurotoxins may be present.

Two prescription medications can bind these toxins: cholestryamine resin and Welchol pills.If taken over several weeks clinical improvement can be seen. See Dr. Burascanno’s abstract at http://www.lymenet.org/drbguide200509.pdf for particulars.

Treating Lyme Borreliosis

No one antibiotic is always effective for treating Lyme disease. The choice of medication and the dosage are based on multiple factors.

The factors include:

• duration and severity of the illness
• presence of coinfections
• immune deficiencies
• prior use of immunosuppressant drugs
• age
• weight
• gastrointestinal function
• blood levels
• and patient tolerance.

Because we now know how the bacteria penetrate deeply into the tissues, higher doses are recommended than before.

Antibiotics:

There are four types of antibiotics in general use for Lyme disease:

• Tetracyclines
• Penicillins
• Cephalosporins
• Erythromycin

Other Antibiotics sometimes used:

• Metronidazole (flagyl) may be more effective in killing off the cyst form when combined with one or two other antibiotics. However, the side effects can be quite serious.

• Rifampin has been used for decades for the treatment of tuberculosis and meningitis, but may be effective in treating Bartonella, Ehrlichia, Mycoplasm and Borrelia. Side effects and drug interactions must be closely monitored.

• Benzathine Penicillin is often used on an intramuscular or intervenous basis. Clinical observation indicates that in many patients it is more effective than oral antibiotics and compares closely to intravenous therapy if the dose is high enough.

• Ceftriaxone treatment; A subset of patients have severe, longstanding illness despite antibiotic treatments which have eliminated the disease in less ill individuals. Higher doses of ceftriaxone in a pulsed-dose regimen has been successful for some in these cases. A protocol developed by Cichon in 2002 is used as the current standard of care with this medication.

Additional Observations:

• If treated early, Lyme is treated for four to six weeks

• If treated late it usually requires a minimum of four to six months of continuous treatment. Treatment must be individualized.

• If a patient has been ill for many years it may require open-ended treatment regimens and some patients will require ongoing maintenance therapy for years to remain will!

• Several days after the onset of appropriate antibiotic therapy symptoms often flare due to the release of “antigenic material” and possibly bacterial toxins. This is referred to as a Jarisch Herxheimer-like reaction.

• Monthly flares presumable represent recurrent Herxheimer-like reaction. The more severe the reaction, the higher the germ load, the more ill the patient! In very ill patients liver enzymes may even elevate and in that case the treatment may need to be slowed. In general, when these flare-ups disappear and there is improvement without the Herxheimer reaction, it is an indication of genuine improvement.

Treatment Failure indicators:

• Non-compliance
• Alcohol abuse
• Sleep deprivation (napping is encouraged in the afternoon)

The Patient’s Job

• Keep a daily diary of symptoms, temperature readings in the late afternoon, notes from physical therapists and cognitive testing. this will help determine the best course of treatment.

For details, go to http://www.lymenet.org/drbguide200509.pdf

Blessings,

Cynthia