There are many misconceptions when it comes to Lyme disease. From placing too much weight on the presence of a bullseye rash for disease identification to only testing for one strain of Lyme bacteria, many widespread beliefs and practices negatively impact those suffering from Lyme disease and co-infections. One of the most problematic of these common misconceptions is putting too much faith in antibiotic monotherapy (the use of only one antibiotic) and ignoring how long it takes for Lyme disease to go from an acute to a chronic form.

In this article, I will go over a new study from Tulane National Primate Research Center that was recently released in November 2023. In this study, the researchers helped answer the pressing question of how long certain antibiotics are actually effective at killing Lyme bacteria. 

How quickly do you need to take doxycycline? 

When you initially catch Lyme, the general treatment that the CDC, doctors and the Infectious Diseases Society of America (IDSA) recommend is to take a short round (10-14 days) of doxycycline. That simple approach can work well—if you catch it early enough. 

However, when it comes to chronic Lyme, taking a round of doxycycline simply doesn’t work. 

When does this transition happen? How long of a window do you have after getting infected with Lyme before doxycycline doesn’t work to eradicate the infection? Do you treat this as a simple disease? When does it become something more complicated? 

We will run through some research today that helps answer some of these questions. 

Our main questions are:

How fast do you need to get doxycycline for it to work?

When do the success rates start to drop?

10-20% failure rate in those treated for Lyme

We’ll start with a study from July 2023 that we covered earlier this year. That chronic Lyme study was produced from the first research grant given by the National Institute of Health (NIH) toward studying chronic Lyme disease, aka post-treatment Lyme disease syndrome (PTLDS).

In the opening of their research grant, they state that there are about 476,000 new Lyme cases per year in the United States. They discovered that in those who have already received treatment for Lyme disease, there is about a 10-20% failure rate. This causes that (10-20%) group of people to enter into a chronic state of Lyme disease.

Most chronic Lyme patients present multiple symptoms

In the next study from Belgium in 2022 called “Nonspecific symptoms and post-treatment Lyme disease syndrome in patients with Lyme borreliosis,” they tested patients who received antibiotic treatment within about 30 days. In one group there was a 6% failure rate, and in the other group, there was about a 20% failure rate. 

The lower failure rate of 6% involved those who had only presented the classic bullseye rash as an indication of infection. The 20% failure rate involved those who had disseminated body-wide symptoms, like body aches and pains and neurological symptoms.

Most people I encounter are in that disseminated category, meaning you have joint pain, neurological problems, and other physical and neurological manifestations of the disease. From neurology and rheumatology to the ER, patients with Lyme who are experiencing these disseminated symptoms are trying to find answers and discover what’s wrong with them. 

This study helped us realize that there can already be a 20% failure rate using the standard doxycycline protocol within 30 days of being infected. That’s an extremely high failure rate.

Treating Lyme 4-6 months after getting infected

Many of the patients who have walked through my door didn’t discover their Lyme infection immediately. It took months or years for them to get answers after jumping from one department to another in the clinics they’ve visited.

In 2012, there was a study done where researchers tested rhesus macaques after infecting them with Lyme bacteria (Borrelia burgdorferi). They then waited 4-6 months to administer the doxycycline therapy. 

The conclusion? Basically, it didn’t work at all

Researchers have known this since 2012, yet the standard medical approach is to keep doing what doesn’t work. How does that make any sense?

We have a terrible success rate by the time we jump to about 4-6 months into the infection.

Latest study supports combination antibiotic therapy

How does the recommended treatment rate when it takes longer than 30 days and less than 6 months to discover the infection and begin treatment? 

How long does it take for Lyme disease to go from acute to chronic?

In November 2023, a new study came out that tested the effectiveness of antibiotic monotherapy 60-90 days after mice were infected with Lyme bacteria. This study called “Superior efficacy of combination antibiotic therapy versus monotherapy in a mouse model of Lyme disease” has already been shared among many members of the Lyme community. 

The general guideline from the CDC that most doctors and IDSA follow is administering monotherapy with doxycycline. It’s one drug, not a combination, so this study offers important insight. 

Just from reading the title, you can see that the researchers are not impressed with the results of monotherapy. They’re going to recommend a more aggressive treatment with multiple combined antibiotics. 

How long does it take for Lyme disease to go from acute to chronic? This shows the effectiveness of various antibiotics against Lyme bacteria.

Is this a new approach?

I’ve had people ask me if this is a new approach in the Lyme community. It’s not new. Lyme doctors who have seen long-term patient success have known this and have been pushing for it since the ‘90s because chronic Lyme is such a serious problem.

In this study, they inoculated mice with Lyme bacteria (Borrelia burgdorferi). They waited two months and then administered antibiotics for one month. They then waited another two months before determining if the infection was still there. 

The table (below) shows the culture results of tissues in monotherapy. 

What I want to highlight from this study is that by 60 days, the standard monotherapy is not working. 

There was still a positive culture in five out of the five mice who had been treated with bactrim, disulfiram, carbomycin, etc. You can go down the list in the table above and see the entirety of the results, but the fact remains: Monotherapies are not effective. Cefotaximine performed the best, but there are still problems with it. 

In the study they state, “Our results support past findings that monotherapy does not eradicate Borrelia burgdorferi infection in all mice and leaves a subset of mice with persistent Borrelia burgdorferi infection.” 

Their conclusion in this study is that by 60 days, antibiotic monotherapy doesn’t work. Translation: There are going to be more people who develop chronic Lyme/post-treatment Lyme. 

In this study, they say that monotherapy doesn’t work well and that combination therapies work better. In future articles and videos, we will cover the topic of combination therapies and the different options there are for Lyme patients. 

If you’ve ever watched videos and read articles from me before, you know I think the antibiotic route causes more symptoms and a rougher road to recovery than taking herbals and nutraceuticals. I think the natural route can beat chronic Lyme and co-infections (with a lower infection recurrence rate) even better than combination antibiotic therapy. We’ll go into that more in future articles.

Why isn’t doxycycline included in this study?

The most surprising thing about this list is that doxycycline isn’t included. This is the most recent study we have and it’s causing a stir in the Lyme community. 

The researchers say doxycycline and ceftriaxone are not included because “they are well studied and are not effective at eradicating the persistent form of Borrelia burgdorferi (Embers et al., 2012, 2017; Hodzic et al., 2019).” They include several references.

However, I strongly disagree with these researchers from Tulane. It’s not because I think doxycycline is effective for chronic Lyme. It’s because I think you should include doxycycline as one of the tested monotherapies. Why? Because it is still the recommended therapy by the CDC. It’s still what insurance covers. It’s still what is recommended by IDSA. It’s still the recommended treatment plan. 

Does your doctor know doxycycline won’t work for chronic Lyme?

When you go to your doctor, they’re going to tell you that doxycycline works. When you go to an infectious disease doctor, they’re going to tell you doxycycline works. But it doesn’t, and we have the research backing this up.

This is an example of how much the research community and the doctor communities/guidelines/organizations/insurance companies can differ in their approaches.  

The researchers say it’s so well established that doxycycline won’t work by 60 days that they didn’t even include it in this study. 

Does your doctor know that? I don’t find many doctors who know this and yet it’s common knowledge among researchers.

None of this information is new to those in the Lyme community. We’ve been saying this for 30 years. But we’re excited to have some studies showing that monotherapy really does not work well 60 days after acquiring the infection. 

How long does it take for Lyme disease to go from acute to chronic?

How long does doxycycline actually work?

So how long does taking doxycycline work? How long does it take for Lyme disease to go from acute to chronic? Take a look at the chart below. 

Doxycycline treatment effectiveness after getting a Lyme infection:

The first couple of weeks: Effective

By 30 days: 10-20% failure rate

By 60-90 days: Probably ineffective

By 4-6 months: Definitely ineffective

Treating with doxycycline in the first two weeks after getting a Lyme infection works quite well. But if it takes longer than 30 days to start treatment, monotherapy is already losing its effectiveness. You have to treat the infection extremely early for this simple type of treatment to be effective. 

The effective treatment window for monotherapy continues to diminish as more research comes out. 

Chronic Lyme needs different care than acute Lyme

For years, those of us in the Lyme community have been trying to hammer the point home that if you take antibiotics early, you can get better quickly. However, once it’s chronic, it’s never that simple. Once the bacteria has morphed into a chronic state, 10-14 days of antibiotics don’t work. It is going to take a more robust plan and program.

Chronic Lyme requires you to kill Lyme in its different phases, help the immune system, and feed your body the raw materials it needs. In our clinic, this more robust, longer-term program typically requires 6-18 months of treatment, not 10-14 days. 

While these studies offer vital and helpful information in understanding and treating Lyme disease, they have major problems in that there are no co-infections tested and measured. This is extremely important to factor in because when I deal with people who are sick with Lyme, 93% of them have co-infections

I want to see studies come out where we test rhesus macaques or mice with Lyme plus Babesia, Bartonella, Anaplasma, or other co-infections because those are the types of cases that walk into my office over 90% of the time.  

You can be better, and you can heal from Lyme disease, but if you’re outside of that 1-month (maybe 2-month) window, it will require a more complete and robust Lyme and co-infection program than 10-14 days of doxycycline to get you better.

To watch our correlating video on this topic, click here.

Summary

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To summarize this article’s information: 

  • When you initially catch Lyme, the general treatment that the CDC, doctors, and IDSA recommend is to take a short round of doxycycline.
  • That simple approach can work well–if you catch it early enough.
  • Once Lyme enters a chronic form, only taking doxycycline won’t work.
  • Our main questions: How fast do you need to get doxycycline for it to work, and when do the success rates start to drop?
  • Doxycycline treatment effectiveness after getting a Lyme infection:
    • The first couple of weeks: Effective
    • By 30 days: 10-20% failure rate
    • By 60-90 days: Probably ineffective
    • By 4-6 months: Definitely ineffective
  • Chronic Lyme requires you to kill Lyme in its different phases, help the immune system, and feed your body the raw materials it needs.
  • In our clinic, this more robust, longer-term program typically requires 6-18 months of treatment, not 10-14 days.
  • Since 93% of patients with chronic Lyme also have co-infections, most studies need to come out that include the presence of these infections as well. These studies need to reflect the complete package of diseases that Lyme patients have.
By Dr. Kyle Warren
Edited by Meghan Feir Walker
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