[December 2023] New Tulane Study on Combined Antibiotics for Lyme

Article: https://news.tulane.edu/pr/tulane-study-combined-antibiotics-more-effective-against-lyme-disease

Study: https://www.frontiersin.org/articles/10.3389/fmicb.2023.1293300/full

I've formatted the successful combinations in a list for easier reading:

Dual combinations:

Doxycycline and ceftriaxone
Dapsone and rifampicin
Dapsone and clofazimine
Doxycycline and cefotaxime

Triple combinations:

Doxycycline, ceftriaxone, and carbomycin
Doxycycline, cefotaxime, and loratadine
Dapsone, rifampicin, and clofazimine

Keep in mind that this is just for Lyme not the co-infections.

Also, there is some stuff about Azlocillin in the study, for those interested.

Thanks for sharing! This makes a lot of sense.

Please confirm.

Table 5 and discussion are showing disulfiram + not clearing the infection.

Any guess on why doxycycline would be chosen over minocycline?

yep, this is one of the issues with trying to extrapolate results in mice to humans

its a good place to start to build data from - but ultimately humans are not mice - and while we are similar in some ways - we are different in others.

i regard Disulfiram as treatment some way down the priority list for my case - due to its often severe side effects for many patients - and also its specificity to Lyme - and lack of activity for other co-infections - so i have not dug into it very much

but from what i recall reading from Rajedas et al - its mechanism of action is poorly understood - and seems to be more driven by metabolites of first pass liver metabolism - rather than the drug itself ( this is common for many pharmaceuticals ) and this may be the explanation for why it did not show great promise in the mice experiments - as its quite possible they metabolise the drug differently.

just a guess - but if i recall correctly even in humans they were experimenting with timed release formulations to try to optimise the ideal metabolism - so it seems to be an important consideration with the drug.

carlnpa said...
Garzie

Or - and I'll say it out loud, disulfiram isn't effective, nor is azlocillin.

I'm not sure Carl

there are some pretty compelling cases of people doing well on it - including full remission

i just don't think we have yet found any single substance that can reliably eradicate Lyme (or some of the other persister cell forming bacteria) once chronic infection stage is reached

most of the effective strategies seem to be long term combinations of standard bacteriostatic antibiotics with one or more persister drugs.

i think the neuropathies may in part or in whole - be due to the fact that some of these infections - eg bartonella and lyme - are known to cluster around nerve fibres - and so - when you kill them with pretty much any means - inflammatory responses are produced exactly where you would ideally not want them - i.e. around the nerves - and damage - and potentially auto-immunity may be triggered there.

we are still in the dark about the exact mechanism of action of many of these substances - some antimicrobials seem to just slow lyme spirochetes down or damage them in some invisible way that makes them susceptible to the immune system - from what i have read most bacteriostatic antibiotics seem to do this - eg tetracyclines and macrolides in normal concentrations

others seem to kill them but keep the microbe intact in the process - and its then consumed by white blood cells and removed - but with likely less immune activation - so is perhaps the ideal mode for an antimicrobial

but intriguingly - disulfiram - according to Rajedas - is known to kind of shatter the spirochete into many many pieces - each of which is likely to be seen as foreign by the immune system and presumably capable of triggering rigorous immune response. i think he speculated that its this shattering effect that leads to the extreme herx reactions experienced by many on Disulfiram

Thanks Girlie, that's really good to know. I do have memory issues.

Sorry to hear about the struggles with memory Girlie!

On the bright side, it does seem like you have most of your life back and are actively doing things again.

I've read that sometimes it can take a few years before the brain recovers but that it eventually will.

Did you read Dr. MR' new article on brainfog?

I know you're in remission but it might still be helpful:

https://www.treatlyme.net/guide/brain-fog-lyme-disease