Long-term therapy with antibiotics – used more frequently than generally known ?
Tuberculosis patients must receive long-term antibiotic therapy for six months or longer because the mycobacterium tuberculosis is a bacterium with a long-generation cycle. Borrelia are also bacteria with long-generation cycles.
In chlamydia infections, the strategy of long-term therapy appears to be equally promising, as several studies have shown (1). In relapsing erysipelas and some forms of acne, long-term therapy with antibiotics is also recommended.
The discovery of protracted bacterial bronchitis in childhood as a cause of chronic cough is interesting. Biofilm-forming pathogens are assumed to be the trigger for this and a prolonged administration of antibiotics is therefore recommended (5).
Another study shows that slow-growing bacteria and/or slow-growing fractions of bacteria are particularly problematic for antibiotic therapy (6). Long-term antibiotic use is recommended for these infections. The duration of therapy depends on the individual conditions of each patient.
Combination therapy – why ?
For infections with Legionella, TBC, HIV (AIDS), the success of the therapy is often improved by a combination of at least two drugs. The same applies to malaria therapy in order to prevent further development of resistance.
Various studies indicate that combination therapy is also useful for Lyme disease treatment.
In chronic chlamydia infections, a combination of antibiotics also appears to show promising results (1), (10). Chlamydia pneumoniae is also a common co-infection for these patients, as well as further infections of mycoplasma spp (2), (11) and/or Yersinia and/or Ehrlichia, Epstein-Barr-Virus (EBV) etc.
The ILADS and the German Borreliosis Society therefore recommend long-term and combination therapy with antibiotics.
Can ceftriaxone alone meet all requirements?
Monotherapy is not the best way to achieve improvements when treating Lyme patients (7). Although it has a good effect on the native spiral form of borrelia, it does not reach the persister forms of borrelia or other pathogens and therefore not the co-infections and accompanying infections. For this reason, a combination of antibiotics should be used.
Ceftriaxone is rarely administered to Lyme patients. There is even evidence of Ceftriaxone promoting the development of persister forms (4). Ceftriaxone and Doxycycline are certainly well suited for the spiral form of borrelia, but not for the aforementioned persister forms, biofilms, intracellular pathogens and co-infectious agents, many of which are also intracellular pathogens.
Monitoring Lyme disease therapy with antibiotics
Both long-term and combination therapy with antibiotics are not without risks, so we recommend that patients receive regular check-ups and take supplements, such as probiotics, to reduce the risk of antibiotic-associated diarrhoea or pseudomembranous enterocolitis. If problems occur during the therapy (e.g. diarrhoea, allergy, etc.), it cannot be continued and the patient must switch to an alternative.
If the patient has no side-effects, their tests show no pathological results and their symptoms improve then there is no reason why the therapy should not be continued. This approach is also acceptable when treating other diseases and infections.
What dose and for how long?
When treating infections, doctors are often faced with two questions regarding antibiotics: What dosage should I use, and how for long should it be prescribed? The answers depends on the individual condition of the patient e.g. age, sex and body weight. It also depends on how the patient absorbs and metabolises the medication (cytochrome P450 system, gender medicine, etc.). Another influencing factor is the actual immune system of the patient, i.e. how much help does it need to “cope” with the infection?
The development of multi-resistant bacteria is enhanced by uncritical, unspecific and oft-changing prescription of antibiotics, as well as via the frequent use of these substances in animal breeding and fattening. This development of resistant bacteria can be reduced by using a combination of antibiotics (8). The development of Borrelia’s resistance is not yet known, so, according to a new study, a more aggressive therapeutic strategy is recommended in treating these pathogens in order to prevent possible development of resistance or loss of the drugs’ efficacy (9).
Supplementary measures can certainly be taken to reduce the length and intensity of antibiotic therapy. These include a change in diet, anti-inflammatory therapy, naturopathic procedures to strengthen the immune system and well-regulated exercise and physiotherapy.
If the immune system can fight the infection on its own, antibiotic therapy is not recommended. If the infected patient has positive antibody titres but no symptoms (i.e. they are not ill), they do not necessarily have to be treated.
It is rather alarming that many patients do not visit their doctor after three weeks of therapy. They seem to be under the impression that their treatment is complete and now just have to wait until the remaining complaints disappear over time. If the complaints do not disappear, their condition is referred to as “post-Lyme syndrome”, which is treated purely symptomatically. However, in our experience the pathogens in these patients are still active.
The work of Professors Zeidler (cf. 1) and Saviola (cf. 3) indicates that pathogens are capable of triggering chronic complaints. Antibiotic therapy can be successful, yet it might not just be a patient’s autoimmune or inflammatory processes that are affected. Perhaps in some cases it is worth considering a ‘double’ strategy.
Antibiotic therapy reduces the amount of pathogens but only the immune system is capable of overcoming an infection and/or eradicating all pathogens. However, if the immune system can control the pathogen so that the patient is symptom-free then this should be sufficient. Some antibiotics (e.g. Azithromycin or Doxycycline) and naturopathic drugs actually have immunomodulatory and anti-inflammatory effects themselves.
The ‘Herxheimer reaction’ can occur during antibiotic therapy. When gram-negative bacteria are destroyed, lipopolysaccharides are released, which can lead to an intensification of existing symptoms. This reaction is often not accurately diagnosed but instead interpreted as an intolerance or allergic reaction to the antibiotic, leading to the therapy being incorrectly terminated. If the Herxheimer reaction occurs, the patient should contact their doctor immediately.
Additional supportive therapies
A significant improvement of the immune system can be achieved via naturopathic therapies and methods.
Infections and autoimmune diseases lead to inflammations and anti-inflammatory therapies can alleviate these symptoms using both synthetic and natural active ingredients.
(1) Prof. Henning Zeidler: „New insights into Chlamydia and arthritis. Promise of a cure?“, Ann Rheum Dis 2014;73:637-644.
(2) Prof. Garth L. Nicolsen et. al.: „Mycoplasma Infections in Chronic Illnesses“, z.B. bei Fibromyalgie, CFS, RA; Medical Sentinel Vol. 4, Oct. 1999; 172-175,191,
(3) Saviola G et. al. „Clarithromycin in rheumatoid arthritis: the addition to methotrexate and low-dose methylprednisolone induce a significant additive value-a 24 month single-blind pilot studie“ Rheumatol Int. 2013 Juli 18
(4) Kersten A., Poitschek S., Aberer E. (1995): Effects of penicillin, ceftriaxone and doxycycline on morphology of Borrelia burgdorferi“, Antimicrob Agents Chemother. 39, 1127-1133
(5) A. Irnstätter et.al. “Chronischer Husten im Kindesalter“, Kinder- und Jugendmedizin 05/2013, Schattauer 2013, S 336 ff
(6) Beatrice Claudi et.al. „Variation of Salmonella in Host Tissues Delays Eradication by Antimicrobial Chemotherapy. Cell, published 14. August 2014, doi: 10.1016/j.cell. 2014.06.045
(7) Klempner M.S. et.al. „Treatment Trials for Post-Lyme Disease Symptoms Revisited“ The American Journal of Medicine, 2013
(8) Hof H, Dörries Rüdiger: “ Medizinische Mikrobiologie”, 5. Auflage, 2014, Georg Thiema Verlag KG, S. 309 (oben), ISNB 978-3-13-125315-6
(9) Roger D.Kouyos et. al.: „ The path of least resistance: aggressive or moderate treatment?, Proc.R.Soc. B 2014 281, 20140566, published 24 September 2014
(10) Rihl M, Kuipers JG et.al. „Combination Antibiotics for Chlamydia-Induced Arthritis: Breakthrough to a Cure?“, Arthritis & Rheumatism, Vol. 62, No. 5, May 2010, pp 1203-1207, American College of Rheumatology
(11) Nicolson GL, Gan R, Haier J.: „Multiple co-infections (Mycoplasma, Chlamydia, human herpes virus-6) in blood of chronic fatigue syndrome patients: association with signs and symptoms“, APMIS 2003;111:557–66.
(12) Feng J, Auwaerter PG, Zhang Y (2015):“Drug Combinations against Borrelia burgdorferi Persisters In Vitro: Eradication Achieved by Using Daptomycin, Cefoperazone and Doxycycline“, PLoS ONE 10(3): e0117207. doi:10.1371/journal. pone.0117207
(13) Jie Feng, Megan Weitner, Wanliang Shi, Shuo Zhang and Ying Zhang: Eradication of Biofilm-Like Microcolony Structures of Borrelia burgdorferi by Daunomycin and Daptomycin but not Mitomycin C in Combination with Doxycycline and Cefuroxime, 2016, Microbiol. 7:62. doi: 10.3389/fmicb.2016.00062