Why Do Chronic Lyme Treatments Fail?

By Dr. Kyle Warren
Edited by Meghan Feir Walker

Have you or a loved one been treated for Lyme disease, only to have persisting symptoms? Unfortunately, a single round of antibiotics often isn’t enough to solve the problem. In fact, some of the most common questions we get in the clinic are “Why do chronic Lyme treatments fail?” and “Why don’t antibiotics cure Lyme disease?” 

In this article, we’ll discuss how Lyme bacteria can become antibiotic resistant, why traditional measures can fail chronic Lyme patients, and why the recommended 2-4 weeks of antibiotics won’t cure everyone. 

As we look through a Johns Hopkins study that touches on those topics, we will also go over better strategies you can take to combat the devastating effects of Lyme disease. 

First off, let’s go over the general recommended CDC guidelines for dealing with Lyme disease. 

General CDC guidelines/recommendations for Lyme disease

Lyme disease can hit individuals differently, depending on many factors, including how well the body is functioning and the state of the immune system.

Because of this wide variance in how symptoms may or may not present themselves, the CDC has some general guidelines for how to handle patients with acute and chronic Lyme disease. 

A few things to note: 

• Some patients may not present symptoms after they have contracted Lyme disease, and after a short two week-round of antibiotics (usually doxycycline), they are sent on their way.
• Many doctors will not give patients antibiotics unless they present the classic bullseye rash, although many who have been bitten by an infected tick will not show a rash. This gross dependence on the bullseye rash as an indication of a Lyme infection has led many doctors and patients astray. 
• Others may present symptoms and a short course of antibiotics may seem to clear their symptoms. In some people, this is all it takes to give their immune systems a boost and clear the infection.
• In other cases, the symptoms gradually grow over time, even after the course of antibiotics is over. 

General CDC protocol based on symptoms:

• Rash: 2 weeks of antibiotics (typically doxycycline)
• Abnormal neurological function: 3 weeks of antibiotics
• Arthritis: 4 weeks of antibiotics

This process may be repeated once by most conventional doctors, but it is still inadequate in many cases.

Standard CDC protocol for “chronic Lyme”

If patients continue to experience symptoms after the standard 2 to (rarely) 4 weeks of antibiotics, most doctors believe you’ve killed the “active” infection, so they opt for symptom-relief medications. 

If you still have anxiety, they give you anxiety meds. If you still have chronic pain, they’ll give you pain meds. The same approach goes for sleep problems and neuropathy. They will primarily take the approach of covering up symptoms after these initial antibiotics are administered.

Why don’t the antibiotics work better?

Lyme bacteria go through various stages, and it’s important to understand this process because it impacts how you need to address it and why antibiotics may not be effective. 

This picture best explains the phases Lyme bacteria go through.

The three main phases of Lyme bacteria inside the body:

First phase: Log

Second phase: Stationary

Third phase: Microcolony (biofilm)

The log phase

When you first get bit, the bacteria are in the log phase. This phase is when antibiotics are the most successful. In this stage, the bacteria is a cork-screw-shaped spirochete that can burrow into tissues. It’s important to note that even in this first phase, using antibiotics still won’t defeat 100 percent of the Lyme bacteria, but it is the most effective timeframe to do so. The hope is that your immune system will kill the bacteria that is left over. The longer you wait, the harder and less effective it is to kill the bacteria with antibiotics alone. 

The stationary phase

In this phase, the bacteria are becoming much more resistant to antibiotics than in the log phase. As the life cycle and metabolism slow down, it becomes much harder to intercept and kill the bacteria because they aren’t as metabolically active. 

The microcolony (biofilm) phase

After the Lyme bacteria has been in your body for about 3 months (this timeframe can vary) it forms microcolonies that are protected by biofilm clusters. The biofilm protects the bacteria and makes it much more resistant to antibiotic treatment because the antibiotics cannot reach the bacteria. Dental plaque that forms on teeth is actually a type of biofilm that protects bacteria. That’s when your dentist uses a tool like ultrasonic waves or a pic to break up biofilm, aka plaque, to clean the teeth. 

The study: The failure rates of antibiotics used to treat Lyme

Now that you know the different phases Lyme bacteria can go through, let’s walk through this study.

The March 2022 Johns Hopkins study we are taking a look at today is titled “Risk of post-treatment Lyme disease in patients with early diagnosed and promptly treated Lyme disease: A prospective cohort study.” These researchers were studying the failure and success rates of the standard antibiotics used for treating Lyme disease in each bacterial phase. 

To see the failure and success rates of each antibiotic or antibiotic combination in each phase of the disease, take a look at their chart. 

Reading the chart

Residual viability:

Residual viability levels indicate the percentage of bacteria that is still left in the body after antibiotics were administered in each phase. 

The red bars: 

Log phase

The green bars: 

Stationary phase

The purple bars: 

Microcolony (biofilm) phase

• The red bars indicate the residual viability of antibiotics used in the log form. During this phase, the antibiotics are the most effective at killing Lyme bacteria and bringing them down to lower levels so your immune system can take over killing what’s left over. 

• The high green and purple bars (the stationary and biofilm phases) illustrate how the effectiveness of the antibiotics goes down dramatically in the stationary and microcolony phases.

From this chart, let’s focus on doxycycline. 

In the early stage of contracting the disease (the log phase), doxycycline, which is the standard antibiotic that’s given, is effective at killing around 70 percent of the Lyme bacteria—not 100 percent, but a high percentage nonetheless. 

When the bacteria have entered the other phases, there is still 80 percent of the bacteria left alive (residual viability) after you try to kill it with these antibiotics. 

Once these later phases have begun, you’ll need other things to help penetrate the biofilm and kill the bacteria. 

Herbs can be more effective at killing Lyme bacteria than antibiotics

In other articles and videos, we go over additional Johns Hopkins studies from 2017, 2018 and 2020 where they showed the effectiveness of antibiotic control groups and 80 different herbs against stationary form Lyme disease. 

The results of these studies were impressive. In them they found many herbs do better against Lyme in the stationary forms than control group antibiotics did. These herbs included oregano, clove, cinnamon, garlic, Cryptolepis, black walnut, Japanese knotweed, cat’s claw, and Chinese skullcap. 

In addition to those incredible results, they also found that many of these agents, such as oregano, clove and cinnamon, work well against Lyme biofilms, and if you can get through or dissolve the protective biofilm, you can reach the bacteria and kill it.

I believe patients get better results when using some of these natural options because they’re more effective at helping fight the bacteria when the bacteria is in these later phases than traditional antibiotics.

How many people have long-term symptoms after standard antibiotics?

One of the main questions the researchers were trying to answer was “How many people have long-term symptoms after standard antibiotics?”

They found that even patients who get antibiotics in the first 30 days still have a 10 percent failure rate and can develop significant fatigue, pain and neurological symptoms.

For those who don’t get antibiotics immediately and wait weeks for treatment (often because of their medical professionals not acting quickly enough), the failure rate may be up to 30 percent, but that’s largely a guess. They only studied people who were given antibiotics right away. 

However, we do know the failure rate will rise the longer you wait. Once you’ve had Lyme for 3-4 months, the success rate of antibiotics goes down dramatically.

All of these lingering symptoms can have significant effects on the patient’s quality of life. They emphasized the devastating impact these symptoms can have on daily activities, work, family and other relationships. The pain, fatigue, neurological problems, etc. are severe enough to where they’re altering what you do, how you interact with others and how you go about life. 

The growing Lyme disease problem

Doctors could relieve the suffering of many patients if they were better and faster at identifying Lyme and other tick-borne illnesses. But, as Johns Hopkins has shown, even patients who do get antibiotics in the first 30 days still have a 10 percent failure rate and develop significant fatigue, pain and neurological symptoms that impact daily activities. 

In Minnesota, there are at least 50,000 cases of Lyme disease every year. At a 10 percent failure rate, that means at least 5,000 Minnesotans are slipping through the cracks of the medical system and suffering from chronic Lyme disease. That’s in Minnesota alone.

This is why it’s imperative that doctors and the public learn about the various phases Lyme bacteria can morph into and that there are other options that can penetrate the biofilm and allow the bacteria to be reached and eradicated.

Our three-fold strategy to kill Lyme disease and heal the body

At our clinic, we know you need to support the entire body as you’re killing the bacteria.

1. You need to take things (herbs, antibiotics or both) that kill Lyme bacteria and other co-infections in each of their phases. 
2. You need to support your immune system so you can help your body kill the bug. That’s what has to finish the job for you.
3. You need to repair the damage that’s been done to your body.

Some of your symptoms are from the bug. Others are from your immune system responding to the bug. And other symptoms yet are from the damage that’s been done to your body as you’ve battled against these bugs.

You must address all three areas in order to get the best results and heal.

Summary

• The three main phases of Lyme bacteria inside the body: Log, stationary and microcolony (biofilm).
• The success rate of antibiotics is much higher when the Lyme bacteria are still in the initial log phase. 
• Once the bacteria have entered their stationary and microcolony (biofilm) phases, the bacteria are much more resistant to antibiotics than in the log phase. In this case, biofilm forms inside your body, protecting Lyme against these antibiotics and preventing them from reaching the bacteria and killing it. 
• Once you’ve had Lyme for 3-4 months, the success rate of antibiotics goes down dramatically. 
• When later phases have begun, you’ll need other things to help penetrate the biofilm and kill the bacteria. 
• Certain herbs did better against Lyme in the stationary and biofilm forms than the control group antibiotics did.
• We recommend using our three-fold approach:
  • Take things (herbs, antibiotics or both) that kill Lyme bacteria and other co-infections in each of their phases. 
  • Support your immune system so you can help your body kill the bug. That’s what has to finish the job for you.
  • Repair the damage that’s been done to your body.

We hope this article has been helpful in your understanding of the phases of Lyme disease and biofilms and that it will help you in your understanding of the disease and how to heal. 

References

• Aucott JN, Yang T, Yoon I, Powell D, Geller SA, Rebman AW. Risk of post-treatment Lyme disease in patients with ideally-treated early Lyme disease: A prospective cohort study. Int J Infect Dis. 2022;116:230-237. doi:10.1016/j.ijid.2022.01.033
• Feng J, Shi W, Miklossy J, Tauxe GM, McMeniman CJ, Zhang Y. Identification of Essential Oils with Strong Activity against Stationary Phase Borrelia burgdorferi. Antibiotics. 2018; 7(4):89. https://doi.org/10.3390/antibiotics7040089
• Feng J, Leone J, Schweig S, Zhang Y. Evaluation of Natural and Botanical Medicines for Activity Against Growing and Non-growing Forms of B. burgdorferi. Front Med (Lausanne). 2020;7:6. Published 2020 Feb 21. doi:10.3389/fmed.2020.00006
• Feng J, Zhang S, Shi W, Zubcevik N, Miklossy J, Zhang Y. Selective Essential Oils from Spice or Culinary Herbs Have High Activity against Stationary Phase and Biofilm Borrelia burgdorferi. Front Med (Lausanne). 2017;4:169. Published 2017 Oct 11. doi:10.3389/fmed.2017.00169