Lyme in a test tube and ILADS' Guidelines validation

Recent test tube studies demonstrate that Lyme is hard to kill. A lab in Johns Hopkins found that over 1500 different antibiotics could not kill Lyme. Viable persisters were found in each case. (1500 different drugs). These persisters were comprised of round body, pleomorphic forms and biofilm-like colonies, as previously described by Sapi.  The study informs us that Lyme does not persist because of antibiotic resistance as it is generally known. For example, bacteria can produce penicillinase, an enzyme witch inactivates the drug. Other bacteria develop pumps wish recognize the antibiotics as toxic and expel the drugs.  Lyme resistance is different, resistance is based on its ability to change its appearance and secure a foot hold within protected colonies. Some antibiotics were found to be more effective against persisters while others were more effective against rapidly dividing spirochete forms. The Hopkins’ lab tried combination therapy and found a single 3 drug combination (cocktail) that completely eradicated the spirochetes (test tube only). The first drug is daptomycin: expensive with limited access; one month of therapy, 30, 0000 dollars. The second drug, cefoperazone, is currently unavailable from the manufacturer. The third drug is doxycycline. Many other combinations of antibiotics using 2 or 3 agents were tested and found to be inadequate. The ingredients of the cocktail are 2 bactericidal drugs and one bacteriostatic drug. In theory these two types of antibiotics can cancel one another out. In clinical practice this is completely untrue.

A newer test tube study shows that the Lyme bacteria may be eradicated with pulsed therapy with a single agent, Rocephin.

Test tube studies cannot be used as a basis for clinical use. But, there is proof of principal. Lyme spirochetes are hard to kill; three drug cocktails and pulsed therapy -- already in clinical use, are vindicated in contradistinction to IDSA recommendations. (Easy to kill, 2 weeks of doxycycline).

What else do we learn? Flagyl is not a “cyst buster.” In the studies it was no more active against persisters than amoxicillin of doxycycline.  Rifampin may convert non-cyst busting drugs, like doxycycline or amoxicillin and confer some anti-cyst capability. By itself Rifampin has no activity against Lyme. Rifampin is added to Lyme culture growth media (ALS new Lyme culture test) to kill non-lyme bacteria.

A major dogma, long bandied about in Lyme circles, a sacred cow, may be incorrect. Flagyl is not a “cyst buster.” Other drugs in cocktails, for example Ceftin, may be doing the cyst-busting, based on published data.

There are other interesting odds and ends. Antifungal drugs, including amphotericin B are active against Lyme. Quinine kills Lyme.  In context, we do not know if these drugs kill Lyme in living systems and this info should not be used as a sole basis for any therapy.