Tuesday, June 2, 2009

Life after Rocephin

What happens after you stop Rocephin? From the Fallon study we know that all cognitive gains achieved after a 10 week course of Rocephin are quickly lost.
Many patients find themselves in the post-Rocephin boat. I will briefly describe the clinical course of one of those patients whom I saw today for a follow up visit. This 57 year old female in many ways is a typical patient with neuroborreliosis. After an acute illness with Lyme disease 3 years ago she subsequently developed progressive cognitive deficits. She experienced memory loss- both short term and long term, difficulty with concentration, poor attention and slow processing. Along with this she had bouts of confusion and disorientation. I picked her up as a new patient 3 months ago. She had been on 4 months of Rocephin and experienced a terrific clinical response. She was afraid of stopping the Rocephin. She had regained at least 70% of lost cognitive functioning. I told her that she could not stay on Rocephin forever and that in my experience Rocephin gains can be sustained with oral antibiotics once the plug is pulled. To reassure her I also let her know that Rocephin could always be restarted.

Here is my thinking. The primary antibiotic which was so effective, Rocephin or ceftriaxone is a third generation cephalosporin. The oral Lyme medicine which most closely resembles Rocephin- a third generation cephalosporin is Omnicef; so I chose this drug. In my experience Amoxicillin would probably have been equally effective.
To boost the blood concentration, and hopefully the effects of Omnicef, I added Benemid or probenicid. This drugs inhibits renal excretion of penicillins and cephalosporins- increasing the blood/brain concentration. In addition I thought that adding additional-synergistic antibiotics, known to pass the blood brain barrier and improve cognition made sense. So I added Minocin and then Tindamax to the regimen.

Now three months off Rocephin she has continued to improve each month. Her level of cognitive functioning is up to 80 to 90 percent of normal.

There have been no published scientific studies to support these findings. However, my impression at this time is that 1) It may be necessary to use Rocephin for significant cognitive dysfunction and that 2) those improvements can be sustained- if not augmented with the use of appropriate oral antibiotics. The duration of therapy cannot be predicted ahead of time; but an open ended approach makes sense as the patient improves. And beyond this some sort of maintenance therapy may be required.

5 comments:

Paraisos said...

A blessing for her having a Doctor who considered in continuing treatment after one month of IV Rocephin; if not she'll be immersed in the darker side of Lyme and the lost mind. Shame for the Doctors who think chronic Lyme means leaving a patient without proper medical treatment to find RECOVERY!
Thanks in her and all of us, name!
What a blessing having you!

girl mark said...

Do you see gall bladder issues with Omnicef or is that just a Rocephin problem? I'm aware of your prior posts that theorize that gallbladder disease may be a Lyme symptom on it's own, not necessarily just damage caused by the antibiotic.

Tigger said...

But what if the patient develops an allergy to Rocephin in the 9th week of IV treatment. Been without abx for 8 weeks and I notice the neurological symptoms returning....what are the alternatives??

Lyme report: Montgomery County, MD said...

I don't normally respond to patient questions. There are alternatives to Rocephin. One patient has had exceptional results with Primaxin. The alternatives are listed in LLMD literature.

Kerry said...

This may prove to be one of the most important blogs for my husband. This gives me hope that he can have neuro improvement! He needs to start the IV treatement I do not think oral is going to do the trick. The illness is too far advanced.