Lyme Disease Co-Infections and Combination Antibiotics: What a Study Found
Co-infections are common.
And treatment may need to reflect that.
Lyme disease co-infections antibiotics were evaluated in a longitudinal study of 140 patients with confirmed tick-borne infections.
In a study by Xi and colleagues, 33% of patients were found to have multiple tick-borne infections, highlighting the complexity of Lyme disease in clinical practice.
Infection Patterns in the Study
Among the 140 participants:
- 66% had one tick-borne infection
- 59% tested positive for Borrelia
- 5% for Rickettsia
- Less than 1% each for Babesia, Bartonella, or Ehrlichia
Notably, one-third of patients had multiple infections, including combinations of Borrelia, Babesia, Bartonella, Ehrlichia, and Rickettsia.
Clinical pattern: co-infections are common and may contribute to persistent or complex symptoms.
Combination Antibiotic Treatment
Most patients were treated with a three-drug antibiotic regimen:
- Cefuroxime
- Rifampicin
- Lymecycline
Treatment duration ranged from 12 to 40 weeks.
Clinical approach: combination therapy was used to address multiple potential pathogens.
Symptom Improvement Over Time
At the first follow-up (118 patients):
- 59% reported pain
- 41% reported neurological symptoms
At the second follow-up (101 patients):
- 41% reported pain
- 30% reported neurological symptoms
There were statistically significant reductions in both pain and neurological symptoms.
Overall:
- Pain decreased by 41%
- Neurological symptoms decreased by 37%
- Fatigue decreased by 17%
Key finding: pain and neurologic symptoms improved, but fatigue remained a persistent challenge.
Exposure History: Often Incomplete
Only 52% of patients recalled a tick bite, and 46% did not report a bull’s-eye rash.
Clinical insight: absence of a tick bite or rash does not rule out Lyme disease or co-infections.
[bctt tweet=”Lyme disease co-infections are common—and combination antibiotic therapy may improve symptoms over time.” username=”DrDanielCameron”]
Common Symptoms in the Cohort
The most frequently reported symptoms were:
- Pain
- Fatigue
- Neurological symptoms (tingling, memory issues)
These symptoms improved over time, although fatigue was slower to resolve.
Clinical Takeaway
Lyme disease co-infections may require broader treatment strategies, including combination antibiotics.
This study highlights the importance of recognizing co-infections and monitoring response over time.
Key question: Could persistent symptoms reflect untreated co-infections rather than treatment failure?
Related Articles:
Intravenous antibiotics helpful for PTLDS
Are antibiotics used to treat Lyme disease effective?
Could dormancy allow Lyme disease to survive antibiotics?
Reference:
- Xi D, et al. A Longitudinal Study of Lyme Disease and Co-Infections Treated with Combination Antibiotics. Microorganisms. 2023.
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.