Combination Antibiotics for Lyme Co-Infections: Study Findings
Coinfections may complicate recovery
Multiple pathogens may overlap symptoms
Fatigue may persist despite treatment
In their article “A Longitudinal Study of a Large Clinical Cohort of Patients with Lyme Disease and Tick-Borne Co-Infections Treated with Combination Antibiotics”, Xi and colleagues looked at 140 individuals who tested positive for tick-borne infections (TBI) with 33% of those patients infected with multiple TBIs.
The authors found the following distribution among the 140 participants:
- 93 (66.43%) had positive antibody responses to one tick-borne infection
- 83 (59.29%) were positive for Borrelia
- 7 (5.00%) were positive for Rickettsia
- 1 (0.71%) each for either Babesia, Bartonella, or Ehrlichia
The remaining 47 (33.57%) patients were infected with multiple tick-borne infections, including Borrelia, Babesia, Bartonella, Ehrlichia and Rickettsia.
The majority of patients were treated with triple antibiotic combination regimens.
Most participants received cefuroxime 500 mg, rifampicin 300 mg, and lymecycline 300 mg. Treatment duration ranged between 12 and 40 weeks.
The most commonly prescribed combination included cefuroxime, rifampicin, and lymecycline. Interest in these antibiotics remains high because clinicians and patients often ask whether combination regimens may better address complex presentations involving Lyme disease co-infections.
In the first follow-up visit with 118 patients, 59% reported having pain and 41% had neurological symptoms. Continued improvement was reported at the second follow-up visit. Out of 101 patients, 41% reported pain and 30% reported neurological symptoms.
“There were statistically significant reductions in the incidence of pain and neurological symptoms between follow-ups,” the authors wrote.
The authors concluded that combination antibiotics improved symptoms with generally good tolerance.
According to the survey, 52% of patients recalled having a tick bite, while 46% did not exhibit a bull’s-eye rash.
The patients exhibited significant improvements in health status during the first and second follow-up visits.
“The three most common symptoms reported by patients were pain, fatigue, and neurological symptoms, such as tingling sensations and memory problems,” the authors wrote.
At the second follow-up visit, “The number of patients suffering from pain, neurological symptoms, and fatigue decreased by 41.43%, 37.50%, and 17.54%, respectively.”
Improvements in pain and neurologic symptoms were more substantial than improvements in fatigue.
These findings highlight why patients with Lyme coinfections may experience more complicated illness patterns and why treatment response can vary considerably.
Authors’ takeaways:
- Most patients in this cohort were infected with Borrelia species, while approximately one-third had co-infections.
- Approximately half recalled a tick bite or bull’s-eye rash.
- Pain, fatigue, and neurologic symptoms remained among the most common persistent symptoms.
Frequently Asked Questions
What were the most common Lyme disease co-infections in the study?
Borrelia was the most common infection identified, while Babesia, Bartonella, Ehrlichia, and Rickettsia were also identified in smaller numbers.
Which antibiotics were most commonly used?
The most common regimen included cefuroxime, rifampicin, and lymecycline.
Did symptoms improve with combination antibiotics?
Pain and neurologic symptoms improved significantly, while fatigue improved less consistently.
Why are Lyme co-infections important?
Multiple infections may complicate symptom patterns, diagnosis, and treatment decisions.
Why did fatigue improve less than other symptoms?
Fatigue remained one of the more persistent symptoms in the cohort, suggesting that some manifestations of tick-borne illness may respond differently to treatment.
Clinical Takeaway
Patients with Lyme disease co-infections often present with overlapping symptoms and more complex clinical pictures.
Combination antibiotics were associated with improvements in pain and neurologic symptoms, although fatigue remained more difficult to treat.
Related Articles
These related articles explore persistent symptoms, diagnostic complexity, and co-existing infections associated with tick-borne illness.
Post-Treatment Lyme Disease Syndrome
Persistent Lyme Disease
Babesia and Lyme Disease
Bartonella and Lyme Disease
Delayed Lyme Disease Diagnosis
References
- Xi D, Thoma A, Rajput-Ray M, Madigan A, Avramovic G, Garg K, Gilbert L, Lambert JS. A Longitudinal Study of a Large Clinical Cohort of Patients with Lyme Disease and Tick-Borne Co-Infections Treated with Combination Antibiotics. Microorganisms. 2023;11(9):2152.
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
What is lymecycline?
Similar retrospective study demonstrating that long-term antibiotics helped patients that would otherwise have been abandoned by IDSA protocols.
Lyme Disease Patient Outcomes and Experiences; A Retrospective Cohort Study, Rogerson AG, Lloyd VK, Healthcare 8[3] 322; 2020-09-04: https://doi.org/10.3390/healthcare8030322
Lymecycline is a tetracycline broad-spectrum antibiotic. It is approximately 5,000 times more soluble than tetracycline base and is unique amongst tetracyclines in that it is absorbed by an active transport process across the intestinal wall, making use of the same fast and efficient mechanism by which carbohydrates are absorbed.[1]
The greater absorption of lymecycline allows for lower dosages to be used; the standard dose of 408 mg is equivalent to 300 mg tetracycline base and, in its action, to 500 mg tetracycline hydrochloride. Lymecycline, unlike tetracycline hydrochloride, is soluble at all physiological pH values.
Sorry to have asked about it before – I had never heard of it.
Lymecycline | C29H38N4O10 | CID 54707177 – PubChem
Lymecycline is not marketed in the USA, however, equivalent drugs are available, such as minocycline and [tetracycline per google
I really enjoy reading this and all of his publications and research on Lyme. One of the few that cares and continues researching.
I so very much agree with you on all of these points! We are incredibly blessed and fortunate to have Dr. Cameron – who is a total game-changer!!
I Googled your question and was able to find this:
https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/lymecycline
Tks
lymecycline typo ?
Lymecycline is a tetracycline broad-spectrum antibiotic that is not marketed in the US. There are similiar drugs in the US marketed under Minocin, doxycycline and tetracycycline.
Hi Dr. Cameron, What are your thoughts on Cefdinir, Minocycline, Clarithromycine combination therapy for chronic/persistent Lyme? Continued thanks for all your invaluable work in the Lyme community!
Treatment decisions in persistent Lyme disease are highly individualized. In my practice, I may consider different combination approaches depending on symptoms, prior response to treatment, tolerance, and whether coinfections such as Babesia are part of the clinical picture. There is no single regimen that works for everyone, which is why careful follow-up and ongoing reassessment are important. Thank you for your kind words and support.