Principles of Lyme disease therapy

How to treat Lyme disease

Chronic Lyme disease treatment is long-term and incorporates the use of oral, injectable or intravenous antibiotics, herbal remedies, food supplements as well as corrective therapies focused on particular Lyme-disease-associated symptoms. Similarly to other chronic infections (tuberculosis, hepatitis C, mycoplasma infection etc), complete eradication of Borrelia is not likely. The practical goal in the therapy of chronic Lyme disease is inducing a dormant state of the disease, where the persisting microorganism is metabolically inactive and does not cause clinically significant symptoms.

The optimal route of antibiotic administration depends on the severity of Lyme disease symptoms. In general, patients with more severe manifestations of Lyme disease require more aggressive therapy with intravenous antibiotics. In addition, patients with various gastrointestinal problems tolerate intravenous antibiotics better than the oral ones. In our clinic, majority of the Lyme patients end up on hybrid protocols combining oral an injectable or intravenous antibiotics plus food supplements and anti-microbial herbs.

What is the “feed and kill” protocol?
When we are dealing with chronic infectious processes some are active and some are dormant. Antibiotics are only effective on active forms when the infection is replicating. Because dormant ones have a very slow metabolic rate they do not intake antibiotics from the surrounding environment and are ineffective. Because of this, we designed protocols specifically for individual infectious agents accelerating their transition from dormant into active state thus making them more susceptible to antibiotics. In general, this approach is commonly used in oncology to make tumor cells more susceptible to chemotherapy.

Preparing for Treatment:
The goal is to eliminate interfering environmental factors such as; heavy metals, Immunogenic foods (gluten, dairy products, soy, eggs, corn etc), and reduce carb consumption.

Address other issues that may be contributing to the symptoms and/or interfere in treatment including; thyroid function, adrenal function and impaired intestinal permeability.

The therapeutic response in Lyme is a step-wise one.

Initially, the therapy results in improvement of brain fog, followed by the improvement of fatigue and then neurological symptoms and joint pain.

Even after successful therapy and induction of the dormant state, a portion of people with chronic Lyme disease deal with asthenia (abnormal physical weakness), which presents in the form of postexertional muscle weakness and fatigue.

The nature of asthenia is typically based on several metabolic abnormalities such as excessive accumulation of lactic acid, depletion of adenosine triphosphate (ATP) the body’s energy source, deviations in urea cycle and accumulation of ammonia, suboptimal production of adrenal hormones, etc.

In addition, the central component of asthenia is based on reduction of the nerve-based motor command to working muscles that result in a decline in the force output.

Frequently, Lyme disease is associated with other tick-born infections such as babesiosis, bartonellosis, Rocky Mountain Spotted Fever etc. Therefore, the successful therapy of Lyme disease ideally should incorporate overlapping approaches targeting co-infections as well.

Chronic Lyme disease is a treatable disease that requires a multidisciplinary approach, compliance with therapy, and a positive attitude.

Things to keep in mind:
Therapy for chronic Lyme disease is not an easy one
It is a journey through good days and bad days, and even miserable days
In most cases, therapy does not follow a textbook protocol and quite often requires frequent adjustments
Be patient and keep a positive attitude and you will be back to a normal life

Antibiotics frequently used to treat Lyme disease

Antimalarials: Hydroxychloroquine, Quinacrine
Carbapenems: Meropenem
Cefalosporins: Cefaperazone, Ceftazidime, Ceftriaxone, Cefuroxime
Fluoroquinolones: Ciprofloxacin
Glycopeptides: Vancomycin
Lipopeptides: Daptomycin
Macrolides: Azithromycin, Clarithromycin
Nitroimidazoles: Mitronidazole, Tinidazole
Penicillins: Amoxicillin, Bicillin, Mezlocillin, Penicillin
Sulfa: Trimetthoprim/Sulfamethoxazole
Tetracyclins: Doxycycline, Minocycline


Brorson O, Brorson SH. An in vitro study of the susceptibility of mobile and cystic forms of Borrelia burgdorferi to hydroxychloroquine. Int Microbiol. 2002 Mar;5(1):25-31.

Dever LL, Jorgensen JH, Barbour AG. In vitro activity of vancomycin against the spirochete Borrelia burgdorferi. Antimicrob Agents Chemother. 1993 May;37(5):1115-21.

Feng J, Auwaerter PG, Zhang Y. Drug combinations against Borrelia burgdorferi persisters in vitro: eradication achieved by using daptomycin, cefoperazone and doxycycline. PLoS One. 2015 Mar 25;10(3):e0117207.

Feng J, Shi W, Zhang S, Sullivan D, Auwaerter PG, Zhang Y. A Drug Combination Screen Identifies Drugs Active against Amoxicillin-Induced Round Bodies of In Vitro Borrelia burgdorferi Persisters from an FDA Drug Library. Front Microbiol. 2016 May 23;7:743.

Feng J, Wang T, Shi W, Zhang S, Sullivan D, Auwaerter PG, Zhang Y. Identification of novel activity against Borrelia burgdorferi persisters using an FDA approved drug library. Emerg Microbes Infect. 2014 Jul;3(7):e49. doi: 10.1038/emi.2014.53. Epub 2014 Jul 2.

Feng J, Weitner M, Shi W, Zhang S, Zhang Y. Eradication of Biofilm-Like Microcolony Structures of Borrelia burgdorferi by aunomycin and Daptomycin but not Mitomycin C in Combination with Doxycycline and Cefuroxime. Front Microbiol. 2016 Feb 10;7:62. doi: 0.3389/fmicb.2016.00062. eCollection 2016.

Hodzic E. Lyme Borreliosis: Is there a preexisting (natural) variation in antimicrobial susceptibility among Borrelia burgdorferi strains? Bosn J Basic Med Sci. 2015 Jul 8;15(3):1-13.

Hunfeld KP, Weigand J, Wichelhaus TA, Kekoukh E, Kraiczy P, Brade V. In vitro activity of mezlocillin, meropenem, aztreonam, vancomycin, teicoplanin, ribostamycin and fusidic acid against Borrelia burgdorferi. Int J Antimicrob Agents. 2001 Mar;17(3):203-8.

Kazragis RJ, Dever LL, Jorgensen JH, Barbour AG. In vivo activities of ceftriaxone and vancomycin against Borrelia spp. in the mouse brain and other sites. Antimicrob Agents Chemother. 1996 Nov;40(11):2632-6.

Sapi E, Kaur N, Anyanwu S, Luecke DF, Datar A, Patel S, Rossi M, Stricker RB. Evaluation of in-vitro antibiotic susceptibility of different morphological forms of Borrelia burgdorferi. Infect Drug Resist. 2011;4:97-113.