IV Antibiotics & Intramuscular (IM) Options

Lyme and co-infection patients with more serious manifestations of infection, especially neurological and cardiac may require intravenous infusion of multiple antimicrobials, often over extended periods of time until infections are controlled.

We offer the option of placement of central lines such as ports, PICCs and other types of indwelling (implanted) catheters for those who need aggressive treatment. Indications for IV antibiotics include loss of ability to walk or use the limbs, ataxia (unstable gait), advanced pain syndromes, neuropsychiatric manifestations that are often mistaken for or co-existing with other conditions such as MS, Parkinson’s, ALS, Bipolar I, psychosis as well as heart conditions such as Lyme carditis, heart block, vegetative endocarditis (Bartonella) and pericarditis to name just a few.

STAPLE IV ANTIBIOTICS FOR VECTOR-BORNE INFECTIONS:

• IV Rocephin (Ceftriaxone) - a cephalosporin antibiotic with excellent blood brain barrier (BBB) penetration, therefore excellent for neurological presentations of Lyme.

• IV Daptomycin - Works by inserting into the cell membranes of Gram-positive bacteria in the presence of calcium. This causes rapid depolarization and leakage of ions, ultimately halting DNA, RNA, and protein synthesis, leading to bacterial cell death, particularly for gram positive bacteria like Lyme. For unique reasons this antibiotic also has excellent activity against Bartonella and has excellent BBB penetration. Requires weekly check of CK to screen for rhabdomyolysis.

• IV Doxycycline - Doxycycline is a very effective medication for Lyme, has significant action against Bartonella, and is the drug of choice for Anaplasma, Ehrlichia, Rocky Mountain Spotted Fever (RMSF) and Murine typhus (Rickettsia typhi). Effective levels for bactericidal (bacterial killing) cannot typically be achieved with oral dosing.

• IV Cleocin (Clindamycin) – Has excellent anti-malarial properties for treatment of Babesia, typically in combination with other anti-malarial agents. Clindamycin also has good activity against the spirochete form of Borreliae (Lyme) species, and appears to hit a small corner of Bartonella.

• IV Metronidazole (Flagyl) – Excellent BBB penetration for killing cystic/round body forms of Lyme and having some activity against Babesia as well.

• IV Ciprofloxacin – An excellent Bartonella medication. We rarely see tendonitis with this particular fluoroquinolone.

• IV Azithromycin – A very good medication for Lyme, moderate activity against Babesia, minimal activity against Bartonella. It has a good safety profile aside from ototoxicity (hearing loss) which we see frequently, therefore we hesitate to prescribe it.
• IV Gentamicin, Vancomycin – These have excellent activity against Lyme, Babesia and Bartonella, but are extremely toxic. Ototoxicity (hearing loss, damage to vestibular system) is common. Few individuals can complete even a 2 week course of these medications, therefore we use them only in dire circumstances.

• IV Levaquin (Levofloxacin) – While a superior medication for Bartonella, tendonitis, sometimes irreversible is not uncommon. We avoid it unless tolerance for oral Levaquin has previously been well-established.

• IM Bicillin-CR or Bicillin-LA – This is a long acting injected penicillin which is typically injected once or twice weekly for Borrelia (Lyme) species. It has excellent BBB penetration, is usually well tolerated with a minimum of Herxing at lower doses. The drawback these days is prohibitive cost in the US and a shortage due to the syphilis epidemic.

• IM Ceftriaxone – An excellent Lyme treatment option for those who can’t access a port or a PICC, but require aggressive treatment. Downsides are it requires daily administration and is uncomfortable. Most can’t maintain injections long-term.