Tuesday, July 2, 2013

Updates: antibiotics

The FDA has issued an alert:  Zithromax is associated with an increased risk of cardiac arrhythmia.  Because of this I have shifted away from this therapy.  I have found that IV Clindamycin, despite early concerns that it causes C. difficile colitis, is a highly effective drug and that it use had been effective for some patients with neuroborreliosis particularly in combination with Flagyl. Recently, several patients have had significant cognitive clearing with use of the combination. Clindamycin is highly active against Borrelia burgdorferi and has good penetration through the blood brain barrier.

Oral Zithromax as long been a cornerstone of anti-babesiosis therapy. Other macrolides, in particular Biaxin may be substituted with a good response. Alternatively, clindamycin or Bactrim may also be used.  These drugs have been used to  prevent resistance of Babesia to Mepron but also have mild anti-parasitic effects independently.

Bartonella:   Levaquin/Cipro  --  largely promoted for the treatment of bartonellosis may not be a good idea.  The fluoroquinolones are associated with tendon /muscle/joint pain with the risk of tendon rupture.  In a recent patient, the agents caused knee swelling and pain, not tendon pain which resolved with cessation of therapy. More importantly however:   Bartonella species may develop resistance to these antibiotics fairly quickly.  Overall, rifampin is a better choice.  A big caveat here as well : rifampin should never be used as monotherapy.  Bacteria develop quick resistance to rifampin when it is used as a sole agent . Traditionally, rifampin has been combined with Zithromax.  Alternatives to Zithromax include doxycycline and others.  I have consistently found  minocycline to be anti-Bartonella, while doxycycline lacks this property.  Biaxin/Zithromax do in fact have some (weak) anti-Bartonella properties although Bactrim remains a better drug for Bartonella.

6 comments:

Tiggerkat said...

what do you think about the use of cryptolepis for Babesia?

I can find one clinical study for its use in malaria, but not sure that transfers to babesia........

Lyme report: Montgomery County, MD said...

Artemesia or artemisinin have been helpful. A lot of herbalist recommend cryptolepsis. A patient or two have found it to be helpful. My recollections are that it is: hard to get, expensive and generally unhelpful. The addition of artemsisinin to pharmaceutical regimens doesn't add anything so I no longer recommend it. But -- by itself artemesinin is a powerful agent.

janie said...

Hi Doc,

Daughter was diagnosed back in 2008 with Lyme and co infections. She treated briefly and then saw Dr. J in Conn.

After about 10 months had to stop antibiotics as it seemed they were causing issues.

Some say it was herxing, but she only felt somewhat better after the 10 months of treatment.

I know and the Dr. knew she needed further treatment, we decided to go with herbs, but then she stopped the herbs.

So now she is a teenager and back on Lyme treatment slowly building dose of IV Rocephin. We are being cautious as she is very sens to many meds, etc. This the first time on IV meds.

She says she feels worse. 4 weeks of 500mg, now she is almost two weeks into 1Gram. Working up to 2Grams and I am sure Dr. will be adding in a cyst buster and other antibotics at some point.

What were your patient experiences on IV rocephin? I read online that some feel worse and did not notice any improvement until three months.

Lyme report: Montgomery County, MD said...

Doctors who believe in chronic Lyme has one thing in common: we believe Lyme is a chronic infection and that long term antibiotics are needed. As for most other things, such as how to treat and for what long we mostly disagree. Every patient is different and every patient responds differently to treatment. You are not going to find easy answers on the internet. Your best bet is talking to your doctor.

Lyme report: Montgomery County, MD said...
This comment has been removed by the author.
LuvLuver said...
This comment has been removed by the author.