There seems to be a debate that rages every day on whether it is a good idea to take antibiotics when treating Lyme disease and co-infections. While there is strong evidence that 4-6 weeks of antibiotics taken within the first 60 days of infection has the potential to completely eradicate persistent infection, there is also evidence that taking them for any length of time after this period can have wildly different effects on patients and the infections themselves.
The purpose of this article is not to debate these facts. Instead, it is to inform any patient or doctor considering prescribing any of the following antibiotics that they can have potentially dangerous side effects on patients with the following pre-existing conditions.
Both patient and doctor should be well informed of these facts before embarking on these treatments for any length of time. What follows is not opinion; it is simply a list of FDA and black-box warnings that includes studies by the NIH (National Institutes of Health) and other organizations regarding these prescription medications. Unfortunately, most of it is not common knowledge among prescribing physicians.
At the same time, there exists a range of herbal/natural treatments that are alternatives to the following treatments that have just as much (in some cases more) reported efficacy and considerably fewer side effects. See herbal treatments.
Fluoroquinolones
(Levaquin, Cipro, Floxin, Avelox, Maxaquin, Noroxin, Penetrex, Tequin, and Zagam)
Pre-existing conditions that can be aggravated: Neuropathy & traveling pain, heart conditions like tachycardia or irregular heartbeats, kidney problems, weak tendons, retinal problems, and depression.
The FDA recently issued a warning on the antibiotics Fluoroquinolones saying that they can cause permanent nerve damage and neuropathy (see warning). This is on top of the warning the FDA issued on the same drugs back in 2008 about their potential to cause severe tendon damage, blinding retinal detachment and kidney failure. The FDA warns that these side effects can occur hours to weeks after exposure to fluoroquinolones and may potentially be permanent.
Aside from the above, the FDA prompted Levaquin manufacturer Ortho McNeil to include a Black Box warning in July 2008 to warn patients that the antibiotic can cause spontaneous tendon rupture and tendonitis as well as seizures, pancreatitis, and severe kidney damage (see warning).
Further, a 2009 study showed that Fluoroquinolones can cause dangerous heart arrhythmias and cardiac arrest (see study).
Azithromycin
(Z-pack, Zithromax, Zmax)
Pre-existing conditions that can be aggravated: Tachycardia, irregular heart rhythms or any existing heart conditions
What follows is a direct quote from the FDA’s website concerning Azithromycin:
The U.S. Food and Drug Administration (FDA) is warning the public that azithromycin (Zithromax or Zmax) can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm (see warning). Patients at particular risk for developing this condition include those with known risk factors such as existing QT interval prolongation, low blood levels of potassium or magnesium, a slower than normal heart rate, or use of certain drugs used to treat abnormal heart rhythms, or arrhythmias. This communication is a result of our review of a study by medical researchers as well as another study by a manufacturer of the drug that assessed the potential for azithromycin to cause abnormal changes in the electrical activity of the heart.
The azithromycin drug labels have been updated to strengthen the Warnings and Precautions section with information related to the risk (see labels).
“Health care professionals should consider the risk of fatal heart rhythms with azithromycin when considering treatment options for patients who are already at risk for cardiovascular events. FDA notes that the potential risk of heart arrhythmias with azithromycin should be placed in appropriate context when choosing an antibacterial drug: Alternative drugs in the macrolide class, or non-macrolides such as the fluoroquinolones, also have the potential for heart arrhythmias or other significant side effects that should be considered when choosing an antibacterial drug.”
Ceftriaxone
(Rocephin)
Pre-existing conditions that can be aggravated: Gallbladder function and biliary sludge, C-Diff infections, diarrhea, yeast overgrowth and intestinal upset
A 2011 study shows that higher doses and prolonged use of Rocephin will cause “biliary sludge” that can turn into gall stones comprised mostly of Rocephin itself (see study). This can happen within 3 to 22 days of administration of the drug and it has been seen to occur in 15 to 46% of the patients studied. Sludge can also occur in the urinary tract [1], and sometimes even gallstone pancreatitis or acute inflammation of the gall bladder can occur [8]. The main risk factors for biliary sludge or gall stones was high daily dosages (over 2 grams daily) and a long term duration of drug therapy (see study).
Further, a 2004 study shows that children were prone to gall bladder and urinary tract complications after only 4-9 days of Rocephin treatment (see study). Both studies show that the above complications may be reversible in adults and children if Rocephin is discontinued, but it can take from 2 to 63 days for the organs to recover.
To make matters worse for Lyme patients, the bacteria likes to hide in detox glands like the gall bladder, so in many cases, Lyme patients’ gall bladders are already compromised. Introducing another aggravating agent into the mix will cause the gland to shut down.
Cyclines
(Doxycycline, Tetracycline, Minocycline)
Pre-existing conditions that can be aggravated: Head or cranial pressure, brain inflammation, C-DIFF, yeast overgrowth and intestinal conditions, and depression.
Doxycycline has been commonly prescribed by physicians across the world as a first-line defense in fighting Lyme disease for decades. This is mainly because there is strong evidence that patients who take a 4-6 week round of this antibiotic within the first 60 days of infection onset can remove all signs and symptoms of Lyme disease and avoid going into the chronic phase of the illness. In fact, doxycycline (along with Amoxycillin, Cefuroxime and Azithromycin) has become a part of International Lyme and Associated Diseases Society (ILADS) treatment standards.
The problem is, a 2003 study reported by the US National Library of Medicine warns that Doxycyline has been shown to cause intracranial hypertension or pressure on the brain. Actually, it has been known for years that Doxycycline and its cousins Tetracycline and Minocycline can cause increased cranial pressure to the point of manifesting symptoms ranging from headaches, blurred or double vision, whooshing sounds in the ears, spinal fluid leaking from the nose to permanent blindness (see study). Patients more susceptible to this condition were slightly overweight women in their childbearing years. In fact, the study issues this warning, “Doxycycline should be prescribed with caution to women of childbearing age who are overweight or have a history of idiopathic intracranial hypertension.”
However, another report also published by US National Library of Medicine states that “intracranial hypertension due to the Tetracycline antibiotics (including Doxycycline) occurs in both sexes, at almost any age, and without concomitant obesity (see report). How quickly a person develops intracranial hypertension after ingesting doxycycline is unknown, but in the largest review of intracranial hypertension induced by minocycline, some participants had used the drug for up to a year before developing symptoms whereas others became symptomatic within two weeks.8 Some dispute whether Tetracyclines cause intracranial hypertension at all since so many individuals are treated with the drug every year without developing intracranial hypertension. However, individual cases have been reported where stopping the drug resolved symptoms and signs of intracranial hypertension, and restarting the drug brought recurrence of intracranial hypertension. In 12 patients with Minocycline induced intracranial hypertension 25% had notable visual field loss.8 Therefore, patients who complain of headache after using Doxycycline should be examined carefully, including their visual acuity, and formal testing of the visual fields.”
Antabuse
(Disulfuram)
Pre-existing conditions that can be aggravated: diabetes mellitus, hypothyroidism, epilepsy, cerebral damage, chronic and acute nephritis, hepatic cirrhosis or insufficiency, mood and psychological disorders, heart conditions, neuropathy and liver toxicity
Disulfiram (Antabuse) has recently been lauded by several well-known Lyme doctors and researchers as a “breakthrough drug” to combat persistent Lyme infection. However, in non-clinical patient reports, there have also been instances of strong mood disorders, neuropathy and of course the strong reactions if any kind of alcohol is introduced into the patient’s system while on the drug. Disulfiram was originally developed to treat alcoholism by blocking the processing of alcohol in the body.
Disulfiram can produce neuropathy in daily doses of less than the usually recommended 500 mg. Nerve biopsies showed axonal degeneration and the neuropathy is difficult to distinguish from that associated with ethanol abuse. Disulfiram neuropathy occurs after a variable latent period (mean 5 to 6 months) and progresses steadily. Slow improvement may occur when the drug’s use is stopped; often there is complete recovery eventually (see study).
The patient must be fully informed of the disulfiram-alcohol reaction. He/she must be strongly cautioned against surreptitious drinking while taking the drug, and he must be fully aware of the possible consequences. He/she should be warned to avoid alcohol in disguised forms, i.e., in sauces, vinegars, cough mixtures, and even in aftershave lotions and back rubs. He/she should also be warned that reactions may occur with alcohol up to 14 days after ingesting disulfiram.
Disulfiram plus alcohol, even small amounts, produce flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion. In severe reactions there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death.
The intensity of the reaction varies with each individual but is generally proportional to the amounts of disulfiram and alcohol ingested. Mild reactions may occur in the sensitive individual when the blood alcohol concentration is increased to as little as 5 to 10 mg per 100 mL. Symptoms are fully developed at 50 mg per 100 mL, and unconsciousness usually results when the blood alcohol level reaches 125 to 150 mg (see study).
The duration of the reaction varies from 30 to 60 minutes, to several hours in the more severe cases, or as long as there is alcohol in the blood.
The National Alliance on Mental Illness (NAMI) reports the following black box warnings for disulfiram:
“Rare cases of nerve pain or nerve damage, psychosis, skin rash, and changes in liver function or liver failure have all been reported with disulfiram. Disulfiram should not be used in people with certain heart conditions or severe heart disease. Talk to your doctor before taking disulfiram if you have heart conditions or have been diagnosed with heart disease.”
What other medications may interact with disulfiram?
When taking disulfiram it is very important to avoid alcohol-containing products, such as cough and cold syrups, elixirs, tonics and certain muscle rubs. When taken with disulfiram, these products can cause severe nausea, vomiting, sweating, and headaches and in rare cases may lead to trouble breathing and irregular heart rhythms. Be sure to talk to your doctor or pharmacist before starting any new medication (over the counter or prescription) while taking disulfiram.
When taken together with a cannabinoid drug called dronabinol (Syndros®), disulfiram can cause abdominal cramps, nausea, vomiting, and headaches. Therefore, disulfiram should not be taken within 14 days of this medication.
Disulfiram may increase the blood concentration of phenytoin, a medication used for seizures.
Some antibiotics or medications for HIV, such as metronidazole, ritonavir, or lopinavir, may increase the adverse effects of disulfiram if taken together with the medication.
Taking disulfiram with the antibiotic isoniazid may cause one to be unsteady on their feet. Be careful standing or walking if taking this combination of medications.
Disulfiram may increase the effects of blood thinners, causing blood clots to form more slowly than normal. Be sure to follow up with your doctor to see if a lower dose of blood thinner is needed while taking disulfiram. (see black box posting)
Dapsone
(Diaminodiphenyl sulfone)
Pre-existing conditions that can be aggravated: Respiratory insufficiency, anemia & other blood disorders, or cardiovascular disease
Dapsone was originally developed as a treatment for leprosy and to prevent pneumonia in the mid-20th century, but it has recently found some traction and reported success with a handful of well-known Lyme doctors lauding its efficacy as a treatment of persistent Lyme infection.
However, there is at least a 15-20% chance that people on the drug will develop Dapsone-induced Methemoglobinemia, which can be life threatening, according to a study by the National Institute of Health (see warning).
Dapsone may also induce a dose-related hemolytic anemia, which is more likely with doses gr eater than 200 mg/day or in patients with existing anemic conditions. Leukopenia, megaloblastic pancytopenia, and hemolysis have been reported. At least one case of pure red cell aplasia has also been reported.
Agranulocytosis (reduction in white blood cells) usually occurs during the first few months of therapy and has been fatal (see warning).
In addition to the warnings listed above, the following syndromes and serious reactions have been reported in patients on Dapsone, according to the SingleCare website (see full warnings).
– Blood related: Blood cell rupturing is common in patients with a G6PD deficiency. Almost all patients demonstrate, a shortened red cell life span, a lowering in blood-cell quality, and a rise in methemoglobin (i.e. blood cells that cannot carry oxygen to tissues).
– Nervous System Effects: Peripheral neuropathy is a definite but unusual complication of Dapsone therapy in non-leprosy patients. Motor loss is predominant. If muscle weakness appears, Dapsone should be withdrawn. Recovery on withdrawal is usually substantially complete.
– Body As A Whole: Further adverse effects reported include: nausea, vomiting, abdominal pains, pancreatitis, vertigo, blurred vision, tinnitus, insomnia, fever, headache, psychosis, phototoxicity, pulmonary eosinophilia, tachycardia, albuminuria, the nephrotic syndrome, hypoalbuminemia without proteinuria, renal papillary necrosis, male infertility, drug-induced Lupus erythematosus and an infectious mononucleosis-like syndrome.
People treating for late-stage Lyme are already experiencing an array of painful symptoms and they trust their doctors not to prescribe treatments that might cause even more serious and permanent damage. Please consider the above and inform your physician of these dangers before starting any of the above prescriptions.
The above material is provided for informational purposes only. The material is not nor should be considered a substitute for medical advice, diagnosis, or treatment.