Antibiotic Combinations Show Activity Against Lyme Disease in Culture
Laboratory studies continue to explore how different antibiotics affect Borrelia burgdorferi. In vitro research suggests that certain combinations may be more effective than single drugs, particularly against stationary phase organisms.
This raises an important question: can combination antibiotic therapy improve treatment outcomes in Lyme disease? Findings from laboratory studies provide insight, but clinical implications remain uncertain.
The authors identified three sulfa drugs and trimethoprim from FDA and NCI compound libraries 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.”
Combination Therapy Showed Greater Activity
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 single agents
- Four-drug combinations were more active than three-drug combinations
- Combinations including dapsone, minocycline, cefuroxime, and either azithromycin or rifampin showed the greatest activity
- However, these combinations were still less active than daptomycin + cefuroxime + doxycycline, which completely eradicated stationary phase cells in this model
Clinical Context and Safety Considerations
Dapsone, trimethoprim, and sulfamethoxazole are approved for other conditions. Dapsone, used in leprosy treatment, may be associated with hemolysis, methemoglobinemia, hepatitis, and skin reactions.
Trimethoprim-sulfamethoxazole (Bactrim, Septra) is widely used but has its own safety profile. Sulfachlorpyridazine is not currently in clinical use.
Daptomycin is reserved for serious infections such as bacteremia and endocarditis. Potential adverse effects include muscle injury, eosinophilic pneumonia, and interactions with statins.
Limitations of In Vitro Findings
This study was conducted in vitro, meaning results were observed in laboratory conditions rather than in patients. Activity against stationary phase organisms does not necessarily translate into clinical effectiveness.
The authors emphasized the need for further research in animal models and clinical settings.
What This Means for Lyme Disease Treatment
This study illustrates a broader principle: laboratory findings may identify promising treatment strategies, but clinical application requires careful evaluation.
Patients with persistent symptoms may benefit from review of Lyme disease symptoms, understanding testing limitations, and consideration of coinfections that may influence treatment response.
References
- Feng J, Zhang S, Shi W, Zhang Y. Activity of Sulfa Drugs and Their Combinations against Stationary Phase B. burgdorferi In Vitro. Antibiotics (Basel). 2017.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
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?
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.
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?
You have raised questions that are yet to be resolved. It is difficult to study transmission given the extensive exposure in a lifetime.
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?
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.
Is there any specific, combination of antibiotics to treat ALS Lyme? Any other supplements will help for antibiotics resistant patients?
ALS and Lyme disease share some similar characteristics. Any evaluation should also include a neurologist. Any treatment must be individualized.
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?
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.
Cameron, I am newly diagnosed with Lyme, Bartonella, Mycoplasma and B. Burg. My Lyme Dr. Prescribed me Minocycline, Flagyl, Vibratabs and Valtrex, I am very ery sensitive to alot of medications and honestly I am afraid to take all of these pills. I have started a herbal protocol but it seems as though I am sensitive to some of these as well. Do you have any suggestions?
I typically start slower in patients sensitive to medications. I am curious why you mentioned Minocin and Vibratabs. Vibratabs are brand name doxycycline. I would not prescribe both.
Back in 2016 I had best results with a doxycycline + azithromycin + cefuroxime combination.
I was bit by a black legged tick in the fall 2012 and a black legged tick nymph in 2013. I became ill the first time in three months after the first bite. Never did quite feel well until an extended course of doxycycline, then an extended course of azithromycin added to that, then an extended course of cefuroxime added, all in combination. Took that combination until I presented well.
I find each of the antibiotics you have taken by themselves or in combination helpful for my patients without the treatment proposed in the culture. I also find treatment for Babesia helpful.
Hello dr. Cameron, what do you think about the combination of azithromycin and cefuroxim at the same time for a 10 year old boy with chronic lyme? Thank you!
I have used the combination in a few cases. I still have to individualize treatment and evaluate for other causes