Macrolide therapy of chronic Lyme Disease.

 Med Sci Monit. 2003 Nov;9,11:PI136-42.  Macrolide therapy of chronic Lyme Disease.
Donta ST.
Boston University Medical Center, 650 Albany Street-8th Floor, Boston, MA 02118, U.S.A.
BACKGROUND: Macrolide antibiotics are highly active in vitro against B.burgdorferi, but have 
limited efficacy in the treatment of patients with Lyme Disease. As macrolides are less active at a 
low pH, their poor clinical activity might be due to localization of borrelia to an acidic endosome, 
and their activity improved by alkalinization of that compartment with hydroxychloroquine. 
MATERIAL/METHODS: 235 patients with a multi-symptom complex typical of chronic Lyme 
disease, ie fatigue, musculoskeletal pain, and neurocognitive dysfunction and with serologic 
reactivity against B.burgdorferi were treated with a macrolide antibiotic, eg clarithromycin, and 
hydroxychloroquine. RESULTS: Eighty% of patients had self-reported improvement of 50% or 
more at the end of 3 months. After 2 months of treatment, 20% of patients felt markedly 
improved, 75-100% of normal; after 3 months of treatment, 45% were markedly improved. 
Improvement frequently did not begin until after several weeks of therapy. There were no 
differences among the three macrolide antibiotics used. Patients who had been on 
64hydroxychloroquine or macrolide antibiotic alone had experienced little or no improvement. 
Compared to patients ill for less than 3 years, the onset of improvement was slower, and the 
failure rate higher in patients who were ill for longer time periods. CONCLUSIONS: These 
results support the hypothesis that the Lyme borrelia reside in an acidic endosome and that the 
use of a lysosomotropic agent augments the clinical activity of macrolide antibiotics in the 
treatment of patients with chronic Lyme Disease. In contrast, the efficacy of tetracycline in such 
patients is not affected by hydroxychloroquine.
93.5:  1: Vet Microbiol. 2005 May 20;107(3-4):285-94 Antibiotic treatment of experimentally 
Borrelia burgdorferi-infected ponies.  Chang YF, Ku YW, Chang CF, Chang CD, McDonough
SP, Divers T, Pough M, Torres A.  College of Veterinary Medicine, Cornell University, Ithaca, NY 
14853, USA.
The objective of this study is to determine whether doxycycline, ceftiofur or tetracycline could be 
effectively used to treat equine Lyme disease. Ponies experimentally infected with Borrelia
burgdorferi by tick exposure were treated with doxycycline, ceftiofur or tetracycline for 4 
weeks, 28 days. Doxycyline and ceftiofur treatment were inconsistent in eliminating 
persistent infection in this experimental model. However, tetracycline treatment seems to 
eliminate persistent infection. Although serum antibody levels to B. burgdorferi in all ponies 
declined gradually after antibiotic treatment, three out of four ponies treated with doxycline and 
two out of four ponies treated with ceftiofur, serum KELA titers were raised again 3 month after 
treatment was discontinued.Five months after antibiotic treatment, tissues aseptically collected 
at necropsy from ponies with increased antibody levels after antibiotic treatment also showed 
culture positive to B. burgdorferi in various post-mortem tissues.However, all 
four-tetracycline treatment ponies showed a negative antibody level and culture negative from 
post-mortem tissues. Untreated infected ponies maintained high KELA titers throughout the 
study and were tissue culture positive

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