How is Lyme treated?

The rate of infections with B. burgdorferi and other tick-borne pathogens are increasing nationwide, and researchers are discovering new, previously unknown species that cause Lyme disease. When Lyme disease is accurately diagnosed and properly treated during the early stage of disease, patients often recover completely.

Misdiagnosis, delayed diagnosis, and/or inadequate treatment can result in disseminated infection that can have a significant and long-term impact on a person’s daily functioning, cognitive abilities, mood, and overall health. Co-infections often result in more serious and complex illness. Timely, accurate, diagnosis and treatment is therefore critical for the best outcome in patients!

Colorado physicians as well as physicians nationwide have different approaches to treating Lyme disease.

It can be challenging to find effective treatment in Colorado for Lyme and tick-borne diseases. Some physicians believe Lyme can not be contracted within Colorado. Others believe Lyme disease is always cured by a short course of antibiotics. Many are wary of the controversies surrounding Lyme disease treatment. Many Coloradans affected by Lyme and tick-borne diseases have difficulty finding a medical professional trained to diagnosis or treat disseminated or late stage Lyme disease and co-infections, and not all Coloradans are receiving accurate nor timely diagnosis.

The protocol of single dose doxycycline was reinforced by a recent article in the Journal of Emergency Medicine, recommending it as a prophylactic for people bitten by a black-legged tick in areas where the rate of ticks infected with Lyme bacteria is greater than 20%. However, several problems exist that suggest this single dose of doxycycline may not be the best prophylactic for Lyme disease.

There are medical care providers experienced in treating and supporting patients with the complexities of Lyme and tick-borne diseases, though many patients may have to travel hours or even out of state to access these providers. A LLMD is a Lyme Literate Medical Doctor, a doctor trained in diagnosis and treatment of Lyme and other tick-borne infections. Many LLMDs utilize treatment guidelines designed by the International Lyme and Associated Diseases Society (ILADS) and/or alternative treatments and protocols. These practitioners disagree with the IDSA and CDC about the treatment of Lyme disease. Since there is no official certification to become an LLMD, Coloradans should know that any practitioner may refer to themselves a LLMD. Doctors may have differing approaches to treatment.  A doctor trained through ILADS or other CME programs may gain experience and skills necessary to better diagnose and treat patients with Lyme or other TBDs.  ILADS, Lyme Disease Association, Inc., and provide a Doctor Referral system to assist patients to locate an LLMD.

Colorado needs more physicians trained in the diagnosis and treatment of Lyme & other tick-borne diseases!

Ying Zhang
Dr. Zhang is a professor of molecular microbiology and immunology at the Bloomberg School of Public Health at Johns Hopkins University.

Antibiotics are used to treat Lyme disease

The specific type of antibiotic varies for each patient, and by the stage and severity of the infection and presence of any co-infections. Antibiotic treatment may also differ for young children and pregnant women. Patients with severe presentations, certain neurological or cardiac forms of illness, or ongoing symptoms may require intramuscular or intravenous treatment. The presence of a co-infection may require a more complex treatment plan. Recent studies are finding that antibiotic drug combinations are proving more effective at eradicating persister cells responsible for ongoing illness in some patients in vitro, but controlled studies in humans have not yet been conducted. Dr. Ying Zhang from John Hopkins University is currently researching the effectiveness of combination drug protocols.

In addition to antibiotics

Many health care providers may recommend alternative, natural, holistic or homeopathic approaches to treatment or for supportive care. These treatments can strengthen the immune system and assist in the body’s ability to heal. Dietary changes, nutritional support as well as Chinese herbs and acupuncture may also aid your body in healing. There are many protocols involving natural antimicrobial and other supportive herbs developed by practicing physicians tailored to meet the needs of the individual patient, their unique symptoms and response to treatment.

Breakthroughs in treatment research

Lyme disease continues to be the most prevalent tick-borne disease in the United States and one of the most difficult to treat for a growing number of patients. Researchers across the country are focusing on new treatments for effective eradication of the demonstrated persistent Lyme bacteria.

A group of researchers from Johns Hopkins Bloomburg School of Public Health recently identified several essential oils, derived from common spice or culinary herbs, that have better antimicrobial activity against the bacteria that causes Lyme disease than some antibiotics. In this recent study, researchers screened a panel of 34 essential oils, and identified the three most effective against Borrelia burgdorferi (Bb), the bacteria which causes Lyme disease, in the laboratory. These oils include oregano, cinnamon bark and clove bud. Dr. Ying Zhang, one of the researchers in this study, is a Professor of Molecular Microbiology and Immunology at Johns Hopkins Bloomberg School of Public Health. Dr. Zhang is a leader in finding more effective treatments for drug resistant and persistent bacterial infections. Dr. Zhang is a leader in research targeted at finding effective treatments for drug resistant and persistent bacterial infections and has directed several projects towards finding more effective treatments against the persistent form of Bb.

In another study, laboratory research published by Dr. Eva Sapi of New Haven University, shows the effectiveness of whole leaf stevia against Borrelia burgdorferi, the spirochete that causes Lyme disease. The effectiveness of Stevia was compared to doxycycline, cefoperazone, daptomycin, and their combinations.  Important to note is that Stevia was effective as a bio-film buster in conjunction with antibiotics.

Both Dr. Ying Zhang’s study and Dr. Eva Sapi’s studies were performed in-vitro (meaning it was conducted in a petri dish in a laboratory). And while laboratory research is critical to the advancement of science, the effectiveness of these herbs in humans will not be known until human studies are conducted.

Dr. Richard Horowitz, LLMD and author of “How Can I Get Better? An Action Plan for Treating Resistant Lyme & Chronic Disease,” is currently conducting clinical studies using combinations of antibiotics with and without Stevia for his patients with chronic Lyme disease. He has also published recently, The Use of Dapsone as a Novel “Persister” Drug in the Treatment of Chronic
Lyme Disease/Post Treatment Lyme Disease Syndrome.

Dr. Kenneth Liegner, LLMD and author of In the Crucible of Chronic Lyme Disease: Collected Writings & Associated Materials has also recently published, Disulfiram (Tetraethylthiuram Disulfide) in the Treatment of Lyme Disease and Babesiosis: Report of Experience in Three Cases.  September 8, 2019 Dr. Kenneth Liegner Interview with Disulfiram for Lyme Support Group can be watched here.

Dr. Brian Fallon, from Columbia University Lyme & Tick-Borne Disease Research Center is currently recruiting for a clinical trial to study the effects of Disulfiram on patients with Lyme disease.

Treatment for Lyme disease may not be enough

The recommended treatment for Lyme may not work for co-infections that can be transmitted through the bite of the same tick or from a separate tick bite. A practitioner who understands tick-borne diseases will consider the possible need to both test for and treat co-infections as well as Lyme disease.

The Controversy About Lyme Treatment

There is controversy about the proper treatment for Lyme disease. The National Guidelines Clearinghouse (NGC) removed the Infectious Disease Society of America (IDSA) guidelines (in February 2016) because they were out of date. Their official statement:

“It was removed from the NGC database because the guidelines no longer met the NGC Inclusion Criteria pertaining to date. More specifically, the NGC inclusion criteria require that all guidelines represented in the NGC database have been developed, reviewed or revised within the last five years. All guidelines that no longer meet these criteria are removed from the NGC site on an annual basis.”

The only NGC endorsed treatment guidelines specific to Lyme disease in the U.S. are peer reviewed Evidence Assessments and Guideline Recommendations created in 2014 by International Lyme and Associated Diseases Society (ILADS).  NGC was originally created in 1998 by AHRQ in partnership with the American Medical Association and the American Association of Health Plans (now America’s Health Insurance Plans).  The contract that supported the NGC ended August 2018, and funds to continue support for the NGC were unavailable.

The Infectious Disease Society of America (IDSA) is currently in the process of revising their guidelines and the CDC continues to endorse the outdated guidelines. There is much contention from the Lyme community regarding patient representation in the revision process,  as well as with the draft guidelines that have been proposed.

ILADS offers an annotated appendix with comparisons of the IDSA and ILADS guidelines.

The ILADS treatment guidelines published by the NGC are not endorsed by the Centers for Disease Control (CDC). This controversy leaves patients and physicians to navigate conflicting recommendations. Part of the reason for the debate is that there is no diagnostic test currently available that can determine whether the bacteria have been effectively eliminated from the body after treatment. Further, there is much debate about how to treat Late Stage, Chronic or  “Post Treatment Lyme Disease”. Some argue that continued antibiotic treatment is the right course, while others cite risks associated with long-term antibiotic use. The course of medical care should be determined between he patient and their medical care provider on an individual basis.

The International Lyme and Associated Diseases Society (ILADS) offers a Physician Training Program. Their goal is to foster excellence in care for Lyme disease patients, addressing the challenges and changes in effectively diagnosing and treating tick-borne diseases. Scholarships are available.

Other Continuing Medical Education programs that can aid medical care providers in gaining experience with Lyme and other TBD’s can be found of our Physician Training page.

Both Colorado physicians and patients need to be aware of the status of this disease and the guidelines so that you may best advocate for yourself, your loved ones or your patients.

Prior infection with Lyme disease does not create immunity. Even if treated successfully, re-infection is possible with additional tick exposures and relapses of infection are may occur even with what is deemed as adequate treatment.