In culture, novel combinations of antibiotics prove effective for Lyme disease

Lyme disease can be difficult to treat. “One possibility is that persisting organisms are not killed by current Lyme antibiotics,” according to Feng and colleagues from the Department of Molecular Microbiology and Immunology, Johns Hopkins University. As reported in the journal Antibiotics, the authors examined the relative activity of drugs for activities against B. burgdorferi stationary phase cells. [1]

 

by Daniel J. Cameron, MD MPH

The authors identified, from an FDA drug library and an NCI compound library, three sulfa drugs and trimethoprim for study. “Dapsone, sulfachlorpyridazine and trimethoprim showed very similar activity against stationary phase B. burgdorferi enriched in persisters; however, sulfamethoxazole was the least active drug among the three sulfa drugs tested.” [1]

Combinations of antibiotics were more effective in eradicating B. burgdorferi in stationary phase cell culture.

• Sulfa drugs combined with other antibiotics were more active than their respective single drugs;

• Four-drug combinations were more active than three-drug combinations;

• Four-drug combinations (dapsone + minocycline + cefuroxime + azithromycin and dapsone + minocycline + cefuroxime + rifampin) showed the best activity;

• Four-sulfa-drug–containing combinations still had considerably less activity than daptomycin + cefuroxime + doxycycline used as a positive control which completely eradicated B. burgdorferi stationary phase cells.

Dapsone, trimethoprim and sulfamethoxazole are drugs on the market for other indications. Dapsone is an antibiotic commonly used in combination with rifampicin and clofazimine for the treatment of leprosy that can lead to hemolysis, methemoglobinemiam, hepatitis, cholestatic jaundice, and rashes. The combination of trimethoprim and sulfamethoxazole are marketed under the names Bactrim and Septra. Sulfachlorpyridazine is not currently used.

Daptomycin is used in the treatment of systemic and life-threatening infections of the skin and skin structure, such as Staph aureus bacteraemia, and right-sided Staph aureus endocarditis. It is marketed in the United States under the trade name Cubicin. Side effects include high and low blood pressure, swelling, insomnia, diarrhea, abdominal pain, eosinophilia, dyspnea, injection site reactions, fever, hypersensitivity. Rare cases of eosinophilic pneumonia have been reported. Myopathy and rhabdomyolysis have occurred in patients concurrently taking statins.

The authors stressed the need for further study in vitro and in animal models.

References:

  1. Feng J, Zhang S, Shi W, Zhang Y. Activity of Sulfa Drugs and Their Combinations against Stationary Phase B. burgdorferi In Vitro. Antibiotics (Basel), 6(1) (2017).


10 Replies to "In culture, novel combinations of antibiotics prove effective for Lyme disease"

  • Angela
    04/19/2017 (1:12 am)
    Reply

    Dr. Cameron, my daughter has many symptons of Lyme. She tested and mycoplasma was the only one that showed up from the Lyme test. . She has voice problems, swallowing problems, hair loss, sensory issues like smell is very strong to her, neurological issues make walking difficult, pain, numbness, brain fog, and so on. She never remembers being bitten by a tick. She has tried oral antibiotics but can never stay on them very long. Now she is weaker and feels like her digestive system is slowly shutting down,; swallowing is difficult. Is there anything she could do to build up her immune system before tackling antibiotics again? How difficult is it to do immunoglobulin IVs?

    • Dr. Daniel Cameron
      04/19/2017 (7:13 am)
      Reply

      I am sorry to hear your daughter remains ill. It is hard to judge if a mycoplasma is the cause of an illness. It can be difficult to tolerate any treatment. IV antibiotics can also affect the stomach even with probiotics. There may be regimen(s) available if your reach out to your doctor. The alternative medicine field and IVIG have been proposed but it is difficult to evaluate without an one on one assessment. You may also need to make sure you do not have another illness.

  • Jennifer
    04/28/2017 (12:43 pm)
    Reply

    I carried both of my children while I had Lyme disease. At the time didn’t know that I had it, but I’m always worried that I’ve passed it on to one or both of them. Every time they complain of any kind of ache I’m worried. I know they have done tests on cadavers with MS, ALS, and I think it was dementia, but when the brain stem was tested they all came back with the Borrelia bacteria. My mother has MS. Do you think it’s possible that she passed this virus onto me? I have never had a tick bite to my knowledge. When my test finally came back positive, I asked my mother if she ever remembers me having a tick as a child. She didn’t. So either I was bitten as a child or I wasn’t bitten at all and it was passed to me. I mean that’s how I see it. What is your opinion?

    • Dr. Daniel Cameron
      04/29/2017 (11:15 am)
      Reply

      You have raised questions that are yet to be resolved. It is difficult to study transmission given the extensive exposure in a lifetime.

  • Tim
    05/02/2017 (6:28 pm)
    Reply

    Dr. Cameron, have any of your patients used the Daptomycin + cefuroxime + doxycycline combination referenced in the article reviewed here? What are the potential downsides/negative side effects in vivo?

    • Dr. Daniel Cameron
      05/04/2017 (12:19 am)
      Reply

      I have followed their in vitro results. I have not seen results beyond their cultures. It is unclear if the in vivo results will be as good or if there are any additional side effects in vivo. I have been reluctant to add Daptomycin to the regimen until more information is available.

  • Carlos
    07/10/2017 (3:33 pm)
    Reply

    Is there any specific, combination of antibiotics to treat ALS Lyme? Any other supplements will help for antibiotics resistant patients?

    • Dr. Daniel Cameron
      07/12/2017 (6:40 pm)
      Reply

      ALS and Lyme disease share some similar characteristics. Any evaluation should also include a neurologist. Any treatment must be individualized.

  • Stephanie
    07/13/2017 (3:08 pm)
    Reply

    I did 2 months of iv daptomycine, doxy and oral ceftin because the lyme dr I was seeing said john Hopkins found this to be the cure.
    8 months later I’m not better. Was that a waste of time?
    I have left that dr and just started seeing a new one who has me in rifampin with supplements because a lot of my symptoms point to bart even though my test was negative. I asked if it should be combined with another antibiotic and she said not at this time.
    I was you patient when living in ny . What do you think?

    • Dr. Daniel Cameron
      07/15/2017 (10:35 pm)
      Reply

      Daptomycin was helpful in the test tube. It still needs more research to determine if it will help in people. It can be difficult to determine who will benefit from additional antibiotics.


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