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Persistence of B.burgdorferi in Rhesus Macaques; antibiotics can be effective

Posted by sdonta on 24 Jan 2012 at 09:02 GMT

The article by Embers et al adds compelling evidence that the relapsing, persisting symptoms in patients with Lyme disease is likely due to continuing infection. The pathophysiology of the continuing symptomatology remains to be defined, but it is likely that it is a combination of a virulence product and host response.
The assumption made that "long-term" antibiotic treatment is not effective is based primarily on a clinical trial that showed that treatment with 1 month of intravenous ceftriaxone followed by 2 months of oral doxycycline was ineffective in patients with Lyme disease and chronic symptoms. The reasons for failure of this regimen are likely that ceftriaxone may not be curative in chronic illness because it does not penetrate intracellular compartments and/or its transient improvement seen in some patients is due to a non-antibiotic action, ie effects on glutamate transport in the nervous system. Doxycycline does not appear to be effective in chronic illness because either the dose commonly used, ie 200mg daily, is inadequate, or only a limited amount of free drug is available to diffuse out of the circulation into cells because of it being highly protein-bound. There is substantial and compelling observational evidence over the past 20 years that there are more effective treatments that use one of two regimens, ie tetracycline alone, in doses of 1500mg/d and which is not highly protein-bound compared to doxycycline, thus allowing more drug to diffuse into cells, or the combination of a macrolide antibiotic and a lysosomotropic agent (eg hydroxychloroquine), this combination supporting the hypothesis that, even though the borrelia may be present in subcutaneous tissues, their reservoir is in an acidic endosome. Depending on the duration of prior symptoms, either of these two treatments appear to result in resolution of symptoms if given over a number of months, 3-6 months if symptoms present for less than a year, 18-24 months if symptoms present for more than 3 years. Until such time that clinical trials and other research can be conducted to validate these observations and further define the actual pathophysiology of the illness, these regimens can be used to successfully treat the disease.

No competing interests declared.

RE: Persistence of B.burgdorferi in Rhesus Macaques; antibiotics can be effective

Baker replied to sdonta on 06 Mar 2012 at 07:52 GMT

Since the anti-inflammatory properties of tetracyclines are well known, couldn't they have accounted for the beneficial effects i.e., resolution of symptoms, in the studies that you cited?

No competing interests declared.