Really interesting study on long-term treatments for chronic infections of mixed involvement

It's difficult to summarize this study because it's packed with information but I'll do my best.

https://www.ncbi.nlm.nih.gov/pmc/articles/pmc10294829/

General ideas:

- They examined 10 cases of late tick-borne diseases.

- The mixed involvement part means the patients had different mixes of Borrelia, Babesia, Anaplasma, and Bartonella.

- The patients were treated with long-term antibiotic and antiparasitics, with treatment ranging between 13 to 60 months.

- All of them experienced complete remission of severe motor deficits, with a "Kurtzke disability score" of 0 two years after the end of the treatment protocol.

And the protocols were as follows:

(please double check as I'm tired, copy and pasting most of it, and not proofreading)

Anti-Borrelia treatments:

- Primary treatment consisting of a 35-day regimen of intravenous ceftriaxone 2 g/d with oral doxycycline 200 mg/d
- Followed by a 2–3-month oral regimen with doxycycline 200 mg/d-azithromycin 500 mg/d (DA) if possible
- In case of incomplete primary results or recurrence, patients had at least 2 supplementary 35-day intravenous ceftriaxone cycles with oral doxycycline 200 mg.

Anti-Babesia treatments:

- Specific treatment using a 21-day regimen of atovaquone 1500 mg/d-azithromycin 500 mg/d (At-A) was administered in case of initial or secondary Babesia positivity
- It was repeated in the presence of symptoms evocative of Babesia.

Anti-Anaplasma and anti-Bartonella treatments:

- Patients with a positive serology for Anaplasma phagocytophilum and/or Bartonella serology were treated using a 3-month oral regimen of doxycycline 200 mg/d-azithromycin and 500 mg/d-rifampicin 300 mg/d, repeated in case of failure.

Hope this helps a bit! Also I found this really nicely worded:

"Long-term protocols require great effort from patients and sustained monitoring by physicians. Their cost is also considerable and may multiply by 50 to 100 times the therapeutic financial investment when compared to habitual short treatments.

However, what price-tag can one put on the benefit of the return of an adult person to complete motor autonomy and to work? Moreover, on that of a teenager to normal life? These human advantages are enormous. The cured patients, after having experienced a long neurological nightmare, shared moving testimonies about the dignity of their new life. Patient 8 returned to his supermarket director’s job after a 33-month interruption and decided to have a baby with his partner. The baby duly arrived."

yep, good find Rainy

seem like sensible combo's

is actually a little surprising that they appear to have success for some hard cases with less harsh abx and shorter courses than we often hear about from LLMD's protocols - and from people on here

but perhaps that is partly because those LLMD's often treat the toughest cases - and the ones that get better quicker tend to move on and not post so much on forums such as this one

Dr J also says in one of his recent youtube videos on IV abx - that he still treats people orally who cannot afford of get coverage for IV abx - and they do get better - it just takes them much longer ( he prefers it for around 10-15% of his patients he says - for things like oral abx intolerance or just v v sick ).

so oral cephalosporins might be substitutable for the IV in those protocols listed in the study

as Blazer says - cause for hope

In addition to my previous thanks: The bartonella treatment seems to be the harshest, isnt it?

I alwys thought Rifampin + Tetracycline Abx OR Macrolide Abx would be the first line - or am i wrong here.
(the babesia and borrelia treatment looks way less harsh than that)

BlazerGermany said...
In addition to my previous thanks: The bartonella treatment seems to be the harshest, isnt it?

Only one of the patients tested positive for bartonella. They prescribed rifampicin for bartonella, which I found ineffective. However their babesia protocol (atovaquone/azithromycin) can be effective on bartonella, so it's not clear what killed the bartonella in that one patient. They also used this babesia protocol on another patient (number 7) who tested negative for babesia but was symptomatic, so it's not clear what that patient was actually infected with, it could have been bartonella or babesia.

BlazerGermany said...
I alwys thought Rifampin + Tetracycline Abx OR Macrolide Abx would be the first line - or am i wrong here.

I used minocycline for bartonella, and found it effective. They used doxycycline rather than minocycline, but not specifically for bartonella, but possibly this killed bartonella.

People on this forum seem to prefer minocycline for bartonella, or find it more effective than doxy. I'm not aware of any scientific investigation into which drug is more effective.

BlazerGermany said...
(the babesia and borrelia treatment looks way less harsh than that)

I would think IV ceftriaxone (for borrelia) would be harsh.

They state "all patients had at least 3 IV ceftriaxone cycles (35 days) with oral doxycycline (2-3 months)." That's at least 9 months.

I used completely different drugs to treat borrelia, but I'd agree with the timeframe, "mean active treatment duration of 20.1 + 6.6 months" seems realistic to me.

I found that if I hit borrelia hard, the herx would get bad after a few weeks, and I'd back off and then take a few months to recover. So, like these patients, I ended up doing cycles of around 3-4 months. I've seen improvement, but still haven't completely gotten rid of the borrelia. Borrelia is difficult.

Yeah the Ceftriaxon iV can be harsh aswell. Maybe I'm just afraid of rifampin because of the urine color side effect. Makes it kinda weird.

But yeah eventually some abx hit other infections. My LLMD even thinks the abx course he has given me effectivly hit bartonella instead of borrelia (I wasn't tested for bart, I just showed some bart symptoms). I would be very happy if that is true - that would be one infection less to deal with. And as you stated correctly, borrelia alone is hard enough to deal with...

Thanks for the answers

Thank you guys for the great discussion BlazerGermany, The Dude Abides, Garzie & Quin.

Garzie I hope the treatment goes well for you!

RainyCloud said...


Garzie I hope the treatment goes well for you!

hi Rainy - actually i was in that post referring to the abx combo's i tried a few years ago - it helped me a bit maybe 25-30% improvement after several months - but my liver enzymes went high - and i was risk averse so stopped

i don't know if it would have been successful if i had toughed it out - but i appeared to have plateaued

after a couple of years of gradually layering mainly herbs and methylene blue with bromelain etc - i am much further forward that i was then - perhaps past 50% recovered - so i am experimenting at the moment with some Dr J type pulsed antibiotics approach - layered over the top of the treatments that have got me to where i am now in the hope that this will move me forward again.

too early to say as yet as i have only done one pulse - but the herx was stronger than i expected - stronger than when i took the abx before -
i suspect there is some synergy with the other treatments - MB and bromelain in particular are known to enhance the effectiveness of abx - and i suspect some of the antimicrobial herbs do to.

i need to go slowly - step by step - as i have to be able to look after myself

i hope you are making progress also

all the best !!

Just coming back to this study

i think there are a couple of positives worth highlighting

1, that the doctors did not use any novel or super toxic drugs - just common or garden type antibiotics that are widely available - and the people still got better - and these people were really very sick - some of the sickest with Lyme and co-infections - bedbound or wheelchair bound

2, that these protocols were essentially pulsed protocols - as abx were given in cycles that were repeated if symptoms re-occurred some time after coming off the abx.
This is significant to me as i think this can be considered evidence that pulsing does in fact work for multiple infections.
Note on pulsing - the In-Vitro lab experiments showed the a relatively mild cephalosporin that definitely doesn't kill all spirochetes in the test tube, even if given in huge concentrations - will actually kill all spirochetes if its pulsed 4 times in normal concentrations.

so the above paper seems to demonstrate that pulsed antibiotics are generally more effective in human trials as well as in the test tube - as we have all seen case reports and heard personal experiences of people who have been on antibiotics longer than 1-2years

OK - it took a long time - 1-2 years - but i think we all know that already - and these people were some of the sickest - so the time line is not surprising in that case

also - the cephalosporins were given in IV form for Lyme - but Dr J treats people orally who cannot afford IV - and they still get better - he says it just takes longer - so i think we can reason that the IV isn't strictly necessary for most people.

so i thought this was am useful and hope inspiring study

good luck everyone!

i was just reviewing this rather important paper again and noticed some of the authors

Eva Sapi, Academic Editor and John Lambert, Academic Editor

Eva Sapi is a well know lyme researcher and microbiologist - has done work on biofilms and live colonies in post treatment animals and humans.

John Lambert is an Irish infectious disease doctor of good standing in Irelands state run health service - and a prominent member of ILADS - i believe he also serves on the board of Invisible International - a reputable tick borne disease education and advocacy non-profit.

so it looks like the two French doctors were those giving the treatments - and these two lyme experts were advising them and overseeing the paper.

its a little surprising the study comes out of France - as, as far as i am aware - they have a big tick born disease burden - but are more backward than even the UK when it comes to recognising and treating it

reporting of Lyme disease is not mandated in France - but is on a voluntary basis by some GPs
latest data show incidence rates of up to 500 cases per 100,000 people per year

i like the paper - after all - its really hard to argue post treatment lyme syndrome - when people who were paralysed get up and walk again after long term antibiotics