Dr Horowitz: Bicillin and Lyme Disease

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Dr Horowitz: Bicillin and Lyme Disease

BICILLIN THERAPY AND LYME DISEASE: A RETROSPECTIVE STUDY OF THE SAFETY AND

EFFICACY OF HIGH DOSE INTRAMUSCULAR BICILLIN IN THE TREATMENT OF CHRONIC

RESISTANT LYME DISEASE

12th LDF Symposium, April 1999, NY, NY

BACKGROUND: Patients with Lyme disease often have incomplete clinical

responses to oral antibiotic regimens. Cimmino et al described 2 patients

with chronic Lyme arthritis resistant to recommended antibiotics regimens

who were cured by long term treatment with benzathine penicillin (Ann Rheum

Dis 1992; Aug; 51 (8) 1007-8). Steere et al performed a double blind study

comparing IM Bicillin with placebo in the treatment of arthritis and

reported a complete resolution of Lyme arthritis in 35% of those patients

(NEJM ,1985; 312:869-874). This study describes the results of high dose IM

Bicillin in a cohort of chronic Lyme disease patients.

METHODS: 35 patients were diagnosed with Lyme disease and other tick-borne

disorders (Ehrlichiosis and/or Babesiosis) from Dutchess County, NY.

Patients were started on either oral antibiotics (Amoxicillin, Doxycycline,

Ceftin or Suprax) plus a macrolide (Zithromax 500 mg/d or Biaxin 500 mg

t.i.d.) or low Bicillin (1.2-2.4 million/units IM weekly) plus a macrolide.

Patients returned weekly for shots and monthly for a medical follow-up where

a CBC, renal and liver function testing was performed. Patients filled out

a Lyme disease screening questionnaire at baseline (Burrascano 1995) with

positive symptoms evaluated at each subsequent visit. They were also asked

to evaluate their percentage of normal functioning before, during and after

treatment. (0-100, 100=normal baseline functioning). Patients who reported

no improvement of symptoms after 1-3 months of oral therapy (plateaued) were

switched to low dose Bicillin therapy (1.2-2.4 million units IM weekly) with

a macrolide, for another 1-6 months. Patients in the low dose Bicillin

group who initially improved but subsequently plateaued, were switched to

higher dose Bicillin therapy, (4.8 million units IM weekly) in combination

with a macrolide, and continued on the regiment for another 1-6 months.

RESULTS: Patients tolerated high dose Bicillin. Local side effects were

common with muscle soreness, and occasional local erythema and pruritis.

Laboratroy values remained within normal limits with rare elevations of the

AST-ALT. Patients often reported Jarish-Herxheimer-type flares during the 48

hours post infection, followed by significant improvement in chronic

symptomatology, including decreased fatigue, myalgias, arthralgias,

headaches, paresthesias and cognitive difficulties. 24 of the 35 patients

reported changes in their % of normal functioning. The mean percent

perceived clinical improvement switching from oral antibiotics to a low dose

Bicillin regimen was 34%. Another 17% improvement was noted upon switching

to the high dose Bicillin regimen.

CONCLUSION: High dose IM Bicillin is well tolerated and is a viable

alternative to oral antibiotic regiments in treatment resistant Lyme

patients. The efficacy of Bicillin may be related to its long half life and

elevated serum levels without the associated peak and troughs of oral

antibiotics.