I have been treating a 46 year old woman with chronic Lyme syndrome for about 18 months. She resides in Montgomery County Maryland and her favorite hobby is(was) gardening. Her presenting complaints were muscle pain, muscle weakness, fatigue, joint pain, neck pain, headaches- with an exacerbation of pre-existing migraines, night sweats, brain fog with forgetfulness- word recall difficulties- short term memory loss- slow cognitive processing and severe depression. She in fact had no idea that she might be suffering with chronic Lyme disease when I suggested the diagnosis. She had been a regular patient for several years treated only for migraine headaches. She had not shared her other symptoms with me because she was worried that I would think she was a hypochondriac. The muscle pain it turns out, was a prominent symptom. She had incapacitating pains in her muscles, especially around her neck and upper back area. Her muscles were knotted and stringy and exquisitely tender. She saw a pain management specialist who diagnosed "fibromyalgia," and treated her with trigger point injections as well as a mix of pain meds. This occurred during the 6 months prior to the Lyme diagnosis. Looking back, it is now clear that she had suffered with fibromyalgia for 20 years. She did not share her symptoms with others in her life. She blamed herself. Somehow, she believed her symptoms represented a personal failing- as she struggled to keep up with other well functioning people around her. Only by sheer will and determination was she able to create the illusion that she was well, when in fact she was getting sicker and sicker.
Finally, almost inadvertently, she shared her story with me.
Her exam had classic Lyme neurological abnormalities. Her labs were fairly unremarkable. Her IgeneX WB for Lyme showed only a positive IgM 31 band with several other IND bands. She wanted a positive test to be convinced she really had Lyme disease. I explained that the 31 band was highly specific. It took some coaxing, but she agreed to start treatment for Lyme. She took Amoxil and Biaxin for about one year. She was nervous about changing medications so we kept to this one regimen. Most of her symptoms improved. Overall, she was 60% better. Persisting symptoms included sweats- which thought were due to menopause AND there had been no change in the fibromyalgia piece of her syndrome. I convinced her to try Mepron, believing that she had sero-negative Babesia. Her insurance turned down Mepron so I substituted Malarone, perhaps fortuitously. Follow up labs continued to be seronegative for Lyme disease by IgeneX standards and Babesia. I also ordered a blood wet mount performed at Clongen. Extracellular motile organisms were present.
After 3 months on Malarone she noted that the muscle pain was almost completely gone. After five months on Malarone all signs and symptoms of fibromyalgia were 100% gone. Her knotty,lumpy muscles were replaced with smooth, normal tissues. This is one very happy patient! Her "menopausal" sweats were also gone.
This is conjecture: She never had Babesia. The motile parasites seen in blood wet mounts may have been responsible for her muscle disorder. We known that these parasites do not live in blood or blood cells- they are extracellular. This means they primarily reside in other tissues. Their numbers must be so numerous that they egress into the blood. A likely place for parasites to live is muscle tissue. One must wonder: could fibromyalgia be caused by muscle parasites, at least in some patients?
This case shows remission of longstanding fibromyalgia with Malarone- used in conjucntion with Biaxin and Amoxicillin.
Tuesday, March 31, 2009
Friday, March 27, 2009
A note on Babesia and parasite
The health officials say that B. microti is the most common strain on the East coast.
B. duncani is only supposed to exist on the West coast. Not true. I get positive results for B. duncani with the same frequency as positive results for B. microti. Serology tests exist for these two strains. I finally got Labcorp to find the right code; they now do the test for B. duncani. Labcorp and Quest are a little mixed up. The old name was B.WA1- the new name is B. duncani. Labcorp and Quest still call it B. WA1. If you order serology for B. duncani they have no idea what you are talking about.
Clongen has a "species" PCR test for Babesia. It includes around 15 known species but does not include B. duncani. For some reason this PCR has to be ordered separately. This can get a bit expensive. I have found many patients who have negative antibodies for both B. microti and B. duncani test positive on the Clongen Babesia "species" test. The theory that many otherwise unspecified strains of Babesia exist in Lyme patients is held up by this data.
On a separate note- we have not yet identified the parasites which are seen in many patient's blood. One organism has been described as tear dropped in shape and has a tumbling motion. It appears to respond to Malarone not Mepron! If Mepron doesn't work for parasite- Babesia like symptoms, it may be worthwhile switching to Malarone.
A positive response is easy to determine- the Herx can be quite dramatic.
B. duncani is only supposed to exist on the West coast. Not true. I get positive results for B. duncani with the same frequency as positive results for B. microti. Serology tests exist for these two strains. I finally got Labcorp to find the right code; they now do the test for B. duncani. Labcorp and Quest are a little mixed up. The old name was B.WA1- the new name is B. duncani. Labcorp and Quest still call it B. WA1. If you order serology for B. duncani they have no idea what you are talking about.
Clongen has a "species" PCR test for Babesia. It includes around 15 known species but does not include B. duncani. For some reason this PCR has to be ordered separately. This can get a bit expensive. I have found many patients who have negative antibodies for both B. microti and B. duncani test positive on the Clongen Babesia "species" test. The theory that many otherwise unspecified strains of Babesia exist in Lyme patients is held up by this data.
On a separate note- we have not yet identified the parasites which are seen in many patient's blood. One organism has been described as tear dropped in shape and has a tumbling motion. It appears to respond to Malarone not Mepron! If Mepron doesn't work for parasite- Babesia like symptoms, it may be worthwhile switching to Malarone.
A positive response is easy to determine- the Herx can be quite dramatic.
Wednesday, March 25, 2009
Suspected Bartonella Psychiatric Herx
A 32 year old woman came to see me one month ago. She was diagnosed with LD in 2003.
At that time she presented with EM rash, stiff neck, and flu like symptoms. She tested positive by ELISA and WB criteria. She was treated with 29 days of Doxycyline.
Over the last 6 years she has experienced a progressive illness. At presentation she complained of: joint pains, muscle pains, head and neck pain, memory loss, anxiety, depression, light sensitivity, and sound sensitivity. Additional symptoms included: intermittent facial rash, dizzy spells, loss of balance, profound fatigue, and irritable bowel symptoms. There was also a history of an elevated rheumatoid factor. The neurological exam was normal save sensory loss of sensation of the lower extremities. Initial Labcorp testing, done at this time showed Lyme WB positive IgM 39 and 41 bands. Her rheumatoid factor and other autoimmune parameters were normal.
She was started on therapy with Omnicef, Mincin and Plaquenil.
Four weeks later she was unexpectedly profoundly depressed. She had increased irritability with mood swings and personality changes. All antibiotics were stopped and she began psychotherapy. She deferred the use of psychotropic medications.
One month later she was feeling much better. Not exactly following my instructions, she had stopped the Minocin and Plaquenil and resumed the Omnicef as solo therapy.
Pains and fatigue were essentially gone. Her mood improved. She still had some mood swings, but the major depression was gone. Her prominent complaints were: persistent dizzy spells, night sweats, neck pain and only right hip pain. Other joint pains had vanished. She noted that bowel changes- constipation and diarrhea had abated but she had increased heartburn.
What had happened?
The patient thought the psychiatric exacerbation was due to Plaquenil. I thought not.
Brain Herx: But- she was fine on Omnicef.
Based on her symptoms it seemed likely that she had Babesia. I had not prescribed any medications that would be active against this parasite- so this shouldn't be the issue.
The question then became: Why the Minocin pych herx but no reaction to Omnicef? Omnicef attacks cell wall synthesis of spirochetes, in this case Lyme. It is relatively ineffective against Bartonella and it has no affect on intracellular L-form disease. Bartonella, according to Psych/LLMD literature is frequently associated with pyschiatric disturbances.
My hypothesis then became: Minocin killed Bartonella, perhaps in the brain leading to this peculiar reaction.
With this in mind, I decided to give all drugs with known activity against Bartonella a wide berth for the time being. These drugs do include- Minocin, Doxycyline, Zithromax, Biaxin, Cipro, Levaquin and perhaps a few others including Bactrim.
Given the night sweats and neck pain I decided to approach the suspected Babesia. My inclination was to start with low doses Artemesin while continuing the Omnicef.
The patient told me should could not afford medications that would not be covered by her insurance drug plan-
With a little more trepidation, I decided to test the waters of Babesia and prescribed a low doses of Malarone.
Another option would have been to continue Omnicef alone. My experience tells me to treat Lyme first.
Side bar: The bowel symptoms were worse but there was increased GERD- heartburn symptoms. The most likely explanation is drug induced gastric irritation of the stomach, although this is not common with Omnicef. I am becoming more convinced that Lyme frequently inhabits the GI tract and can cause symptoms there. Perhaps acid blockers which decrease stomach acidity may help kill gastric Lyme; and, regarding a somewhat related issue, it certainly appears that Asacol, a bowel anti-inflammatory, helps colon related symptoms. I prescribed Prevacid- a proton pump inhibitor which decreases stomach acidity. This should improve symptoms and perhaps aid in killing Lyme in her stomach.
Bartonella psychiatric Herx? Perhaps. We shall see.
At that time she presented with EM rash, stiff neck, and flu like symptoms. She tested positive by ELISA and WB criteria. She was treated with 29 days of Doxycyline.
Over the last 6 years she has experienced a progressive illness. At presentation she complained of: joint pains, muscle pains, head and neck pain, memory loss, anxiety, depression, light sensitivity, and sound sensitivity. Additional symptoms included: intermittent facial rash, dizzy spells, loss of balance, profound fatigue, and irritable bowel symptoms. There was also a history of an elevated rheumatoid factor. The neurological exam was normal save sensory loss of sensation of the lower extremities. Initial Labcorp testing, done at this time showed Lyme WB positive IgM 39 and 41 bands. Her rheumatoid factor and other autoimmune parameters were normal.
She was started on therapy with Omnicef, Mincin and Plaquenil.
Four weeks later she was unexpectedly profoundly depressed. She had increased irritability with mood swings and personality changes. All antibiotics were stopped and she began psychotherapy. She deferred the use of psychotropic medications.
One month later she was feeling much better. Not exactly following my instructions, she had stopped the Minocin and Plaquenil and resumed the Omnicef as solo therapy.
Pains and fatigue were essentially gone. Her mood improved. She still had some mood swings, but the major depression was gone. Her prominent complaints were: persistent dizzy spells, night sweats, neck pain and only right hip pain. Other joint pains had vanished. She noted that bowel changes- constipation and diarrhea had abated but she had increased heartburn.
What had happened?
The patient thought the psychiatric exacerbation was due to Plaquenil. I thought not.
Brain Herx: But- she was fine on Omnicef.
Based on her symptoms it seemed likely that she had Babesia. I had not prescribed any medications that would be active against this parasite- so this shouldn't be the issue.
The question then became: Why the Minocin pych herx but no reaction to Omnicef? Omnicef attacks cell wall synthesis of spirochetes, in this case Lyme. It is relatively ineffective against Bartonella and it has no affect on intracellular L-form disease. Bartonella, according to Psych/LLMD literature is frequently associated with pyschiatric disturbances.
My hypothesis then became: Minocin killed Bartonella, perhaps in the brain leading to this peculiar reaction.
With this in mind, I decided to give all drugs with known activity against Bartonella a wide berth for the time being. These drugs do include- Minocin, Doxycyline, Zithromax, Biaxin, Cipro, Levaquin and perhaps a few others including Bactrim.
Given the night sweats and neck pain I decided to approach the suspected Babesia. My inclination was to start with low doses Artemesin while continuing the Omnicef.
The patient told me should could not afford medications that would not be covered by her insurance drug plan-
With a little more trepidation, I decided to test the waters of Babesia and prescribed a low doses of Malarone.
Another option would have been to continue Omnicef alone. My experience tells me to treat Lyme first.
Side bar: The bowel symptoms were worse but there was increased GERD- heartburn symptoms. The most likely explanation is drug induced gastric irritation of the stomach, although this is not common with Omnicef. I am becoming more convinced that Lyme frequently inhabits the GI tract and can cause symptoms there. Perhaps acid blockers which decrease stomach acidity may help kill gastric Lyme; and, regarding a somewhat related issue, it certainly appears that Asacol, a bowel anti-inflammatory, helps colon related symptoms. I prescribed Prevacid- a proton pump inhibitor which decreases stomach acidity. This should improve symptoms and perhaps aid in killing Lyme in her stomach.
Bartonella psychiatric Herx? Perhaps. We shall see.
Monday, March 23, 2009
Tear of joy
I graduated from medical school 26 years ago. There were 36 hour shifts of on call duty, first as a 3rd and 4th year medical student and then as an intern and resident. I was dedicated. I was totally immersed in a parallel world- the medical world, oblivious to the reality outside the hallowed halls of my hospital. During rare undisturbed moments in the on call room I studied medical texts and current journal articles with inimitable intensity. Shoes were left on in anticipation of the beeper's call to put out the next unknown fire. Those were heady days. Much has happened since. And yet- much is the same. To date medicine has been a satisfying avocation- "Its more than a job," my father, The Physician, would frequently quip. As was usually the case, he was right. Some days, some moments are just better than others and leave an indelible mark. Today I had one those moments.
My ALS lady came back today. Call in motor neuron disease or Lyme imitating ALS, whichever pleases you. When I saw her a month ago for the first time, I cried as I previously posted. I thought the the horse was long out of the barn and that I was hopelessly trying to close the gate. It has never ceased to amaze me the extent to which patients can thwart our prognostications.
I walked into the room. Her head was held up high and she beamed at me brightly.
30 days of Rocephin. She WAS strong enough to hold her head up. She was able to eat and to swallow. She had gained some weight. Ever so slightly, she had begun to move her previously useless right hand.
Unbelievable- She's going to get better! I walked out of the room- with the slightest of tear- this time, a tear of joy. Yes- this was a good day.
My ALS lady came back today. Call in motor neuron disease or Lyme imitating ALS, whichever pleases you. When I saw her a month ago for the first time, I cried as I previously posted. I thought the the horse was long out of the barn and that I was hopelessly trying to close the gate. It has never ceased to amaze me the extent to which patients can thwart our prognostications.
I walked into the room. Her head was held up high and she beamed at me brightly.
30 days of Rocephin. She WAS strong enough to hold her head up. She was able to eat and to swallow. She had gained some weight. Ever so slightly, she had begun to move her previously useless right hand.
Unbelievable- She's going to get better! I walked out of the room- with the slightest of tear- this time, a tear of joy. Yes- this was a good day.
Friday, March 20, 2009
Lyme symptoms: Smell the coffee- before it is too late
A 43 year old female came in to see me within the last several weeks. She is extremely ill. She became ill about 18 months ago. It started with joint pains and cognitive deficits including confusion. She was initially found to have Lyme and Ehrlichia. She was treated with 30 days of Rocephin followed by two months of Doxycyline (Klempner protocol). She was just starting to improve when the treatment was stopped. All of the initial symptoms and more returned. With further testing she showed antibodies to Bartonella. She was treated with Bicillin and Levaquin. The Bicillin, once weekly was continued for 3 months and the Levaquin given for 3 weeks. Treatment was stopped. Again, she was improving some when therapy was stopped. More symptoms came and she kept getting worse. She has two daughters who also developed Lyme disease from the same field trip. She reports that between the three of them they have seen 40 doctors prior to seeing me.
She works for cardiologists. She developed severe hypertension with wild uncontrolled swings in blood pressure. The heart specialists were at a loss.
She has seen numerous infectious disease specialists, neurologists and others. Mostly she was told that she did not have Lyme or tick borne disease. One told her he didn't know how to treat Bartonella. She told me that it appeared that all the physicians were reading off the same script!
Here are a few test results: Lyme IgM positive (CDC-old criteria), Ehrlichia IgG titer 1:1024, Bartonella henselae IgG 1:320.
Several doctors told her the infections were cured because she had IgG titers, not IgM (Ehrilichi and Bartonella).
This lady is very sick. She has profound fatigue, confusion and pain. She has a boat load of other neurological symptoms. I should report that many psychiatric symptoms became much worse with recent re-treatment with Rocephin and Doxycyline.
She presented with a highly abnormal neurological exam. She had diffuse myoclonus- muscle twitching, absent vibratory sensations of the extremities, poor finger to nose testing and a positive Romberg sign.
She has the core constellation of symptoms and findings upon which I base my diagnosis of chronic, systemic LD and neuroborreliosis. With this in mind, I will list the entirety of her current symptoms:
joint pain
random sharp shooting pains
Pain soles of feet
tremors
blood pressure dysregulated
tachycardia
Random muscle twitches
off balance
ringing in ears
sensitivity to sound and light
sweating
confusion
global cognitive problems- too numerous to list
"intestines slow"
increased headaches
sleep disorders
menstrual irregularities: no periods for years, start with antibiotics
psychosis- started after antibiotics were given- visual and auditory hallucinations
Lyme symptoms reflect a multisystem infection and are extremely varied-
For those who misinterpreted my post about Lyme symptoms I wish to clarify: Patients with Lyme disease may and do have all the symptoms listed by Dr. B in his guidelines. This patient even has the psychosis which I largely dismissed. I have seen all of these symptoms and many more in my Lyme patients.
My concern is that symptom check lists used in self diagnosis should not be displayed on the internet, especially when connected to ILADS. All patient varied symptoms need to be seen within a context of the whole clinical picture. Patients may have many isolated symptoms on the check list, which may occur over a period of time. Only a trained physician can decide if these symptoms fit into the overall clinical pattern of Lyme and tick borne illness.
The IDSA is writing letters and giving lectures claiming that self proclaimed LLMDS are essentially quacks and that symptoms attributed to chronic Lyme are vague and non specific. The IDSA claims such symptoms lists have many other causes- not Lyme disease. They are also making the strange claim that antibiotics just make people feel good for some unknown reason.
I spoke with a University scientist yesterday. His lab does research on Lyme. The IDSA got there before we did. He just heard a lecture which specifically debunked the notion that chronic Lyme disease exists. These guys are busy launching a full frontal propaganda war. We (the Lyme community) are busy quibbling about minutia while the walls are falling down around us.
THE TAKE HOME MESSAGE WAS SUPPOSED TO BE: LYME SYMPTOMS ARE IN FACT VERY,VERY SPECIFIC. THE FOCUS IN THIS WAR, WHICH I BELIEVE WE ARE CLEARLY LOOSING, IS TO LIMIT THE DISCUSSION TO THINGS WHICH ARE STRAIGHTFORWARD AND CAN BE READILY DEMONSTRATED.
Lyme patients have: 1) core symptoms which are reproducible in a large population
2) abnormal neurological examinations which are reproducible in a large population
3) abnormal laboratory parameters which are reproducible in a large population and
4) clinical responses to treatment which are reproducible in large populations.
Credible, science oriented physicians, need to go on the lecture circuit and present the other side of the story to these large groups of clinicians and scientists.
We have to win over the hearts and minds of these folks if were are to have any politic success with the legislators.
I unfortunately cannot do this until specific "political" issues which relate to my own situation are resolved.
She works for cardiologists. She developed severe hypertension with wild uncontrolled swings in blood pressure. The heart specialists were at a loss.
She has seen numerous infectious disease specialists, neurologists and others. Mostly she was told that she did not have Lyme or tick borne disease. One told her he didn't know how to treat Bartonella. She told me that it appeared that all the physicians were reading off the same script!
Here are a few test results: Lyme IgM positive (CDC-old criteria), Ehrlichia IgG titer 1:1024, Bartonella henselae IgG 1:320.
Several doctors told her the infections were cured because she had IgG titers, not IgM (Ehrilichi and Bartonella).
This lady is very sick. She has profound fatigue, confusion and pain. She has a boat load of other neurological symptoms. I should report that many psychiatric symptoms became much worse with recent re-treatment with Rocephin and Doxycyline.
She presented with a highly abnormal neurological exam. She had diffuse myoclonus- muscle twitching, absent vibratory sensations of the extremities, poor finger to nose testing and a positive Romberg sign.
She has the core constellation of symptoms and findings upon which I base my diagnosis of chronic, systemic LD and neuroborreliosis. With this in mind, I will list the entirety of her current symptoms:
joint pain
random sharp shooting pains
Pain soles of feet
tremors
blood pressure dysregulated
tachycardia
Random muscle twitches
off balance
ringing in ears
sensitivity to sound and light
sweating
confusion
global cognitive problems- too numerous to list
"intestines slow"
increased headaches
sleep disorders
menstrual irregularities: no periods for years, start with antibiotics
psychosis- started after antibiotics were given- visual and auditory hallucinations
Lyme symptoms reflect a multisystem infection and are extremely varied-
For those who misinterpreted my post about Lyme symptoms I wish to clarify: Patients with Lyme disease may and do have all the symptoms listed by Dr. B in his guidelines. This patient even has the psychosis which I largely dismissed. I have seen all of these symptoms and many more in my Lyme patients.
My concern is that symptom check lists used in self diagnosis should not be displayed on the internet, especially when connected to ILADS. All patient varied symptoms need to be seen within a context of the whole clinical picture. Patients may have many isolated symptoms on the check list, which may occur over a period of time. Only a trained physician can decide if these symptoms fit into the overall clinical pattern of Lyme and tick borne illness.
The IDSA is writing letters and giving lectures claiming that self proclaimed LLMDS are essentially quacks and that symptoms attributed to chronic Lyme are vague and non specific. The IDSA claims such symptoms lists have many other causes- not Lyme disease. They are also making the strange claim that antibiotics just make people feel good for some unknown reason.
I spoke with a University scientist yesterday. His lab does research on Lyme. The IDSA got there before we did. He just heard a lecture which specifically debunked the notion that chronic Lyme disease exists. These guys are busy launching a full frontal propaganda war. We (the Lyme community) are busy quibbling about minutia while the walls are falling down around us.
THE TAKE HOME MESSAGE WAS SUPPOSED TO BE: LYME SYMPTOMS ARE IN FACT VERY,VERY SPECIFIC. THE FOCUS IN THIS WAR, WHICH I BELIEVE WE ARE CLEARLY LOOSING, IS TO LIMIT THE DISCUSSION TO THINGS WHICH ARE STRAIGHTFORWARD AND CAN BE READILY DEMONSTRATED.
Lyme patients have: 1) core symptoms which are reproducible in a large population
2) abnormal neurological examinations which are reproducible in a large population
3) abnormal laboratory parameters which are reproducible in a large population and
4) clinical responses to treatment which are reproducible in large populations.
Credible, science oriented physicians, need to go on the lecture circuit and present the other side of the story to these large groups of clinicians and scientists.
We have to win over the hearts and minds of these folks if were are to have any politic success with the legislators.
I unfortunately cannot do this until specific "political" issues which relate to my own situation are resolved.
Wednesday, March 18, 2009
Long term antimicrobials for non-Lyme disease
Long term antibiotics are and have been used to treat a wide range of medical disorders. It seems the use of long term antibiotic therapy is acceptable for other conditions, except Lyme disease.
Rheumatoid arthritis: Doxycyline and Minocycline have been shown to be effective and used as maintenance drugs. Plaquenil, an anti-malarial antimicrobial drug which is frequently used for the treatment of Lyme disease, is also used long term in the treatment of rheumatoid arthritis and systemic lupus erythematosis.
Periodontal disease: Periostat- a formulation of Doxyclyine has been approved for long term use.
Acne: Doxycycline and Minocycline are frequently used for months and years. Acne, unlike Lyme disease, is a cosmetic disease, not a disabling or life threatening disease. Other antibiotics like Bactrim have also been used.
Chronic prostatitis: Cipro and similar antibiotics are frequently prescribed for 90 days and longer.
Urinary tract prophylaxis: Women with recurrent urinary tract infections have been treated with long term antibiotics to prevent recurrences.
Chronic otitis media- ear infections: Long term antibiotics have frequently been prescribed in children to prevent recurrent ear infections. Although this practice has been discouraged in recent years, current peer reviewed studies have again supported the benefits of this therapy.
Chrohn's disease: Antibiotic therapy, at times long term with Cipro and at time Flagyl, have proved to be beneficial, and safer than other recommended therapies.
Rheumatic fever: For patient with recurrent Rheumatic fever related to Steptoccocal infection, the use of Penicillin orally or by injection, on an indefinite basis has been recommended.
PANDAS: Pediatric Autoimmune Neurological Disorder: This disorder associated with OCD disorder and tics, especially in children, has been treated with long term antibiotics such as Penicillin. Although there may be controversy regarding this therapy, no psychiatrist has had medical board sanctions for prescribing this therapy.
Chronic osteomyelitis- bone infection and diabetic ulcers: Frequently treated with long term or indefinite antibiotic therapy.
Chronic constipation: Gastroenterologists frequently prescribe indefinite Erythromycin for the management of refractory constipation.
Herpes simplex: Valtrex, an anti-viral medicine is frequently prescribed indefinitely for this benign condition.
Toe nail fungus: Lamisil, a potent and potentially toxic antifungal, is routinely prescribed for 90 days for this cosmetic condition.
Q fever: May be a chronic bacterial infection requiring 4 years of antibiotic therapy.
Whipple's disease: Another chronic bacterial infection which routinely requires years of antibiotics and may be fatal.
TB: 6 months of a potent antibiotic, toxic to the liver, is frequently prescribed to prevent TB after exposure.
Active TB: 6 to 9 months of triple antibiotic therapy is required. In the recent past therapy was frequently extended for 2 years.
Coronary heart disease: Associated with elevated C-reactive protein. This is a circulating protein associated with activation of the complement cascade. This is an effector mechanism of the innate and acquired immune system responses. Chlamydia pneumonia, a chronic intracellular bacteria has been found in blood vessel plaques. Long term antibiotics have been studied for this disease.
Malaria: For persons in endemic areas long term antimalarials is frequently employed.
MS and other autoimmune neurodegerative disoders: The use of long term Minocycline and other antibiotics is an area of active research.
This list is by no means comprehensive. But is sure demonstrates the existence of a double standard.
Rheumatoid arthritis: Doxycyline and Minocycline have been shown to be effective and used as maintenance drugs. Plaquenil, an anti-malarial antimicrobial drug which is frequently used for the treatment of Lyme disease, is also used long term in the treatment of rheumatoid arthritis and systemic lupus erythematosis.
Periodontal disease: Periostat- a formulation of Doxyclyine has been approved for long term use.
Acne: Doxycycline and Minocycline are frequently used for months and years. Acne, unlike Lyme disease, is a cosmetic disease, not a disabling or life threatening disease. Other antibiotics like Bactrim have also been used.
Chronic prostatitis: Cipro and similar antibiotics are frequently prescribed for 90 days and longer.
Urinary tract prophylaxis: Women with recurrent urinary tract infections have been treated with long term antibiotics to prevent recurrences.
Chronic otitis media- ear infections: Long term antibiotics have frequently been prescribed in children to prevent recurrent ear infections. Although this practice has been discouraged in recent years, current peer reviewed studies have again supported the benefits of this therapy.
Chrohn's disease: Antibiotic therapy, at times long term with Cipro and at time Flagyl, have proved to be beneficial, and safer than other recommended therapies.
Rheumatic fever: For patient with recurrent Rheumatic fever related to Steptoccocal infection, the use of Penicillin orally or by injection, on an indefinite basis has been recommended.
PANDAS: Pediatric Autoimmune Neurological Disorder: This disorder associated with OCD disorder and tics, especially in children, has been treated with long term antibiotics such as Penicillin. Although there may be controversy regarding this therapy, no psychiatrist has had medical board sanctions for prescribing this therapy.
Chronic osteomyelitis- bone infection and diabetic ulcers: Frequently treated with long term or indefinite antibiotic therapy.
Chronic constipation: Gastroenterologists frequently prescribe indefinite Erythromycin for the management of refractory constipation.
Herpes simplex: Valtrex, an anti-viral medicine is frequently prescribed indefinitely for this benign condition.
Toe nail fungus: Lamisil, a potent and potentially toxic antifungal, is routinely prescribed for 90 days for this cosmetic condition.
Q fever: May be a chronic bacterial infection requiring 4 years of antibiotic therapy.
Whipple's disease: Another chronic bacterial infection which routinely requires years of antibiotics and may be fatal.
TB: 6 months of a potent antibiotic, toxic to the liver, is frequently prescribed to prevent TB after exposure.
Active TB: 6 to 9 months of triple antibiotic therapy is required. In the recent past therapy was frequently extended for 2 years.
Coronary heart disease: Associated with elevated C-reactive protein. This is a circulating protein associated with activation of the complement cascade. This is an effector mechanism of the innate and acquired immune system responses. Chlamydia pneumonia, a chronic intracellular bacteria has been found in blood vessel plaques. Long term antibiotics have been studied for this disease.
Malaria: For persons in endemic areas long term antimalarials is frequently employed.
MS and other autoimmune neurodegerative disoders: The use of long term Minocycline and other antibiotics is an area of active research.
This list is by no means comprehensive. But is sure demonstrates the existence of a double standard.
Treating Lyme causes super-germs- In a pig's eye (or cow)
A frequent criticism leveled against the use of long term antibiotics for Lyme disease is that it contributes to the rise of super-bugs. Is this true?
LLMDS treating chronic Lyme disease typically use older generation antibiotics such as Amoxicillin or Minocycline. The dreaded MRSA- Methicillin resistant Staphylococcus aureus is resistant to Methicillin. Methicillin is an advanced generation penicillin. It inactivates penicillinase, an enzyme elaborated by evolved, resistant strains of Staph. All Staph aureus have been resistant to Amoxicillin for decades! The use of first generation antibiotics play no role in the development of sophisticated- antibiotic resistant bacteria. This argument holds no water. This overstated theory is not supported by decades of clinical practice or published scientific research. Super-bugs grow in an environment oozing with the latest- "super-antibiotics." Where does this occur?
It has been long established that super-bugs have emerged from the hospital environment. Hospitals have been on the cutting edge of using the latest and greatest antibiotics. In general, the newest, hi-tech antibiotics have been prescribed by infectious disease specialists, who have brandished these new drugs like a kid showing off a new shiny toy. To be fair, in recent years, ID specialists have become increasingly aware of this problem and made efforts to reign in the use of such super-antibiotics. MRSA emerged in hospitals and then spread to nursing homes and long term care facilities. It is only after its genesis in these venues that MRSA egressed into the general population. It has long been known that "nosocomial" infections- hospital acquired infections, are different and much more dangerous and antibiotic resistant than infections acquired in the "community."
Are hospitals the main problem then? No.
70% of antibiotics used in the US are used in agriculture. Farmers have access to latest hi-tech antibiotics and use them with impunity, without any oversight by the IDSA of physicians who are rightfully concerned with the advent of highly resistant germs. For the most part this information has remained outside the purview of public awareness and kept on the back pages of print media. The inappropriate use of antibiotics in agriculture is the invisible 800 pound gorilla sitting in the room when it comes to the issue of emerging super-bugs.
When you get down to brass tacks, the use of long term antibiotics in Lyme patients is criticized because the critics believe that a non-existent disease is being treated. If the disease does not exist off course no drugs, let alone antibiotics should be prescribed.
The problem is that Lyme disease is real. It is a multi-system, frequently life threatening disease. Do Lyme drugs cause Superbugs? NO. It is phony issue.
If the IDSA has issue with the existence of chronic Lyme, then lets have a debate about the real issue and the real science.
LLMDS treating chronic Lyme disease typically use older generation antibiotics such as Amoxicillin or Minocycline. The dreaded MRSA- Methicillin resistant Staphylococcus aureus is resistant to Methicillin. Methicillin is an advanced generation penicillin. It inactivates penicillinase, an enzyme elaborated by evolved, resistant strains of Staph. All Staph aureus have been resistant to Amoxicillin for decades! The use of first generation antibiotics play no role in the development of sophisticated- antibiotic resistant bacteria. This argument holds no water. This overstated theory is not supported by decades of clinical practice or published scientific research. Super-bugs grow in an environment oozing with the latest- "super-antibiotics." Where does this occur?
It has been long established that super-bugs have emerged from the hospital environment. Hospitals have been on the cutting edge of using the latest and greatest antibiotics. In general, the newest, hi-tech antibiotics have been prescribed by infectious disease specialists, who have brandished these new drugs like a kid showing off a new shiny toy. To be fair, in recent years, ID specialists have become increasingly aware of this problem and made efforts to reign in the use of such super-antibiotics. MRSA emerged in hospitals and then spread to nursing homes and long term care facilities. It is only after its genesis in these venues that MRSA egressed into the general population. It has long been known that "nosocomial" infections- hospital acquired infections, are different and much more dangerous and antibiotic resistant than infections acquired in the "community."
Are hospitals the main problem then? No.
70% of antibiotics used in the US are used in agriculture. Farmers have access to latest hi-tech antibiotics and use them with impunity, without any oversight by the IDSA of physicians who are rightfully concerned with the advent of highly resistant germs. For the most part this information has remained outside the purview of public awareness and kept on the back pages of print media. The inappropriate use of antibiotics in agriculture is the invisible 800 pound gorilla sitting in the room when it comes to the issue of emerging super-bugs.
When you get down to brass tacks, the use of long term antibiotics in Lyme patients is criticized because the critics believe that a non-existent disease is being treated. If the disease does not exist off course no drugs, let alone antibiotics should be prescribed.
The problem is that Lyme disease is real. It is a multi-system, frequently life threatening disease. Do Lyme drugs cause Superbugs? NO. It is phony issue.
If the IDSA has issue with the existence of chronic Lyme, then lets have a debate about the real issue and the real science.
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