Antibiotics Success with Early Identification, Less Successful if Applied >6mo After Infection

We are good at catching Lyme if you present with an bulls-eye rash.  Many, many people have no idea they ever got Lyme.  It presents as a mild rash about half the time or a flu-like illness that patients simply get better from in a week or two.  The illness generally comes on 1 to 3 weeks after the tick bite so many patients do not even remember being bitten.  Antibiotics for Lyme Disease are the generally recognized as an effective treatment when applied within 3 months of contracting the tick bite.

If Lyme disease presents like a flu, our medical system is terrible at identifying that Lyme is the cause.  This is especially troubling in Neuroborrelliosis which means we get flu like symptoms followed by neurological symptoms such as headaches, chills, burning, tingling, dizziness, or depression.  These symptoms can perpetuate sometimes for years without a clear understanding of the cause.

What we know now is that, in a minority of patients, the immune system is unable to kick out the invader with or without antibiotics for Lyme Disease.  The problem comes because Antibiotics for Lyme Disease are not 100% successful in helping you recover.

  • It is estimated 5-20% of patients suffer from long term fatigue, joint/muscle pain, and functional impairment despite Antibiotics for Lyme Disease. Stats According to Aucott, Crowder, and Kortee 2013; Marques 2008; Weitzner et al. 2015. 20% 20%

In the book Conquering Lyme Disease by Brian Fallon, MD and Jennifer Sotsky, MD they do a great section looking at a 4 studies done in the US on the success (or lack of success) of antibiotics for patients with chronic Lyme.  Here are some of their conclusions.

A study from Krupp et al. in 2003 used one of 55 patients with moderate to severe fatigue.  They received 1 month of antibiotic IV ceftriaxone and then were antibiotic free for months 2-6.  The results showed 69% of the patients receiving the antibiotic had significant improvement of their fatigue, while only 23% of the placebo group showed improvement of fatigue.  The authors found if the patient had a positive western blot test then the antibiotics for Lyme Disease were more likely to be effective (80%).  However, the authors did not recommend 1 month of IV ceftriaxone because it did not show resolution of other symptoms (such as cognition) and many patients suffered side effects.  Click HERE for a link to the study.

Key Take Aways From This Study
  1. Anti-biotics helped patients with post lyme disease syndrome about 69% of the time with their fatigue.  (This means 31% of patients did NOT get relief from their fatigue through antibiotics)
  2. Patients still had neurological effects after antibiotics.
  3. Patients were more likely to show improvement in their fatigue if an IgG Western blot was positive prior to taking antibiotics for Lyme Disease.

For studies like these Dr. Warren likes to test each patient for a Lyme Western blot.  We are more likely to do antibiotics (medical, herbal, or homeopathic) as part of your care if you have a positive western blot for Lyme along with your symptoms.

Antibiotics for Lyme Disease are only one piece to the puzzle

Why Antibiotics for Lyme Disease Are Not the Complete Answer

In Chronic Lyme Disease, not all of your symptoms are coming from the bug.  This means antibiotics for Lyme Disease will no longer fix all your problems.  They are part of the solutions, but not the entire -solution.  Some of the symptoms are coming from persistent Lyme bugs or Co-infections, some symptoms are coming from inflammation independent of the bugs, and some symptoms are coming from damage to tissue (like the nervous system).  Antibiotics only solve one of these 3 problems!  Antibiotics do not take away the inflammation or repair the tissue!

Persistent Organisms Even After Antibiotics for Lyme Disease

It has been shown that patients with Chronic Lyme or Post Lyme Disease Syndrome have persistent Borrelia (Lyme) organisms in their system despite antibiotic treatments.  For this reason it is plausible that repeated courses of antibiotics (medical, herbal, and/or homeopathic) may be helpful in helping patients recover from Lyme Disease.

Persistent Inflammation

It has been shown that patients that suffer from symptoms long after contracting Lyme disease have abnormal inflammation patterns.   The fundamental problem with Lyme disease is your own immune systems combination of over activity (excess inflammation) while simultaneously being ineffective at clearing out the bugs. 

Tissue Damage

Lyme disease can cause damage to parts of the body, which drive persistent symptoms even after the infection is gone.  The 3 most common tissues we see damaged especially after antibiotics for Lyme Disease are the mitochondria (leading to low energy), nervous system, and joints (leading to pain).  The neurological system is the slowest healing system of the body and this is why we do so much to rehabilitate proper nervous system function.

More Reasons Antibiotics For Lyme Disease May Not Work

Lyme Disease has several strategies to hide and evade antibiotics

Borrelia (Lyme) tries to evade antibiotics and your immune system. It does this by doing the following:


1. Forming a Biofilm: A biofilm is a tangled mess of proteins that inhibit access to the bacteria.  I tell patients this is like the thorns in front of the castle in Sleeping Beauty.  This is a physical protection for Borrelia.

2. Forming a Cyst: Borrelia can go into a “cyst” or “round” form which is fairly inactive.  Not all antibiotics which are effective against the normal spirochete form of Borellia are effect against this cyst version.

3. Hiding Intracellularly: Lyme will dive inside your own cells to try and evade detection and elimination.

4. Hiding Inside Parasites: While this part has not been documented, there are many functional medicine doctors who believe Lyme will not only dive in your own cells, but also dive into other organisms in your body (particularly large ones like parasites) to try and evade your immune system.

In the future, I will write another article outlining these challenges in more detail.

One More Reasons Antibiotics for Lyme Disease May Not Work.  The Co-Infections

Having read over a dozen popular Lyme Disease books and having helped hundreds of patients at this point in my career, I have constantly encountered another short coming in the Antibiotics for Lyme Disease thinking.  The problem is this.  Your symptoms may be from a co-infection and not from Lyme Disease.  Antibiotics for Lyme is different than trying to kill Bartonella, or Babesia, or Anaplasma.  One of the biggest short comings in popular Lyme books is how little they talk about these co-infections.  Indeed I recently finished Conquering Lyme Disease Science Bridges the Great Divid by Brian Fallon, MD and Jennifer Sotsky, MD.  This is an excellent book from very smart doctors at Columbia.  However, one of the biggest oversights I see in this nearly 400 page book is there are only 2 pages on Bartonella.  There is only 1 paragraph on Powassan Virus.  There are 3 pages on Babesia.  Missing co-infections causes many patients to not get better.  I do not mean to pick on this book.  I could have chosen many popular Lyme Disease books for this point!

For more information on co-infections please read more of our other articles.  Read Dr. Warren’s Article On Babesia and Anaplasma!

Participants reported a significant decline in health status with chronic Lyme disease and were often unsatisfied with care in the conventional settings.  Negative experiences were associated with reports of dismissive, patroniazing, and condescending attitudes.

Experiences of patients identifying with chronic Lyme disease in the healthcare system: a qualitative study. Ali et al., 2014

In Conclusion: There is Hope!

Antibiotics for Lyme Disease (medical, herbal, or homeopathic) are a useful tool in helping patients with Chronic Lyme to get better.  If you have done antibiotics and not gotten better there are several questions to ask about why that could happen.

Antibiotics for Lyme Disease are part of a program helping you get better

1. Has Lyme morphed to evade the antibiotics I tried to kill it with?

2. Are my symptoms coming from inflammation or tissue damage and antibiotics are not the correct help?

3. Are symptoms coming from a co-infection that the antibiotics did not target?

It is appropriate to put some hope in antibiotics for helping to get you better.  Just don’t place ALL your hope in them.  They are part of the hope, but not the entire thing.


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