posted
Does anyone have experience or knowledge of the relative value of IV antibiotics versus IM antibiotics, particularly when the primary symptom is Brain Fog (from Neurological Lyme)?
Posts: 16 | From Southern Ontario | Registered: Jul 2017
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Lymedad,
I've never heard of any differences between the two. Mostly it is based on the medication and patient's response.
I might add, if this is for a child- the IM shots can be VERY painful even when pain reducing measures are taken.
TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
The Burrascano Guidelines say that IM Bicillin "compares closely to intravenous therapy in terms of efficacy if the dose is high enough." It does not address the symptom of brain fog.
Of course, you would want to try everything else to improve the brain fog before you move to IV or IM treatment from oral treatment.
Once you have ruled out inability to detox, etc. and you have tried Burrascano-style dosages and combinations of antibiotics to hit all 3 forms of lyme without any improvement in symptoms over a number of months, then you would want to consider IV and IM.
Here is the Burrascano quote from page 16 of the Guidelines:
"BENZATHINE PENICILLIN Comparative studies published by Fallon et. al. at Columbia University have shown that parenteral therapy is superior to oral therapy in chronic patients.
Options include intramuscular long acting penicillin G (benzathine penicillin, or “Bicillin-LA”) or intravenous antibiotics.
For an antibiotic in the penicillin class to be effective, time-killing curves show that significant levels of antibiotic must be sustained for 72 hours. Bicillin LA is a sustained release formulation that meets these criteria.
Published studies in children and adults, combined with over a decade of experience with this therapy by front line, Lyme-treating physicians have established the efficacy, safety and usefulness of this medication. In many patients it is more effective than oral antibiotics for treating Lyme, and compares closely to intravenous therapy in terms of efficacy if the dose is high enough.
It is usually administered three or four times weekly for six to twelve months. It has the advantage of being relatively inexpensive, free of gastrointestinal side effects, unlikely to promote the overgrowth of yeast, and has an excellent safety record spanning many decades. Finally, an added plus is that family members can be trained to administer this treatment at home."
I know a top notch lyme doctor who puts her treatment resistant patients on IM Bicillin and she gets very good results.
If the patient has a strong stomach, she first tries orals, adding more and more meds as needed.
Here is a quote from one of her patients:
"If you have a strong stomach she will keep you on orals just adding more.
If not, the penicillin shots she said are working wonderfully for a lot of her patients and she would rather try that before the IV because there are always risks involved with the IV."
So, as you can see, for most cases oral therapy with effective combinations of antibiotics is sufficient. But, for the patient whose stomach cannot handle such therapy, then the doc will move to IM therapy. The last resort is IV.
If you would like to list the oral antibiotic combinations the patient is currently on, perhaps some of us could tell you if it is an effective protocol. Don't list the dosages, as per LymeNet rules.
If the patient's stomach is not handling oral meds, that is a different story. However, even on IM Bicillin, the patient will still have to take some oral meds as I understand it.
Posts: 9931 | From Maryland | Registered: Dec 2007
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TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
Also, read the short paragraph, Treatment Resistance" on page 12 in case that applies to your case.
Posts: 9931 | From Maryland | Registered: Dec 2007
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posted
My doc keeps statistics on all his patients. He says IM is 2% less effective than IV, so they're very close.
Posts: 748 | From Texas | Registered: Feb 2015
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posted
Thanks to all for the quick responses. In this case the patient is an adult with Celiac disease, which impacts absorption of oral antibiotics. In addition to permanent damage associated with a slow diagnosis of Celiac, the situation was compounded by reaction to some medications which were supposed to be gluten-free. With testing we found the offending medications, but significant damage had been done, as evidenced by a TTG test. Many combinations of antibiotics have been tried over the last many months, but the response seems to be always less than expected. Thus it appears that absorption of oral antibiotics may be a significant factor, and we are considering a move to the next step beyond oral. It has been suggested elsewhere that IV may have better impact on Lyme brain fog than IM, which is why we were checking if anyone had personal experience. The IM seems much easier to administer, and with fewer risks. In this case the patient is not concerned with muscle pain from the injection, as any pain would be less intrusive than the current brain fog and headaches.
Posts: 16 | From Southern Ontario | Registered: Jul 2017
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TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
Breaking up above post for easier reading:
Thanks to all for the quick responses.
In this case the patient is an adult with Celiac disease, which impacts absorption of oral antibiotics.
In addition to permanent damage associated with a slow diagnosis of Celiac, the situation was compounded by reaction to some medications which were supposed to be gluten-free. With testing we found the offending medications, but significant damage had been done, as evidenced by a TTG test.
Many combinations of antibiotics have been tried over the last many months, but the response seems to be always less than expected.
Thus it appears that absorption of oral antibiotics may be a significant factor, and we are considering a move to the next step beyond oral.
It has been suggested elsewhere that IV may have better impact on Lyme brain fog than IM, which is why we were checking if anyone had personal experience.
The IM seems much easier to administer, and with fewer risks. In this case the patient is not concerned with muscle pain from the injection, as any pain would be less intrusive than the current brain fog and headaches.
Posts: 9931 | From Maryland | Registered: Dec 2007
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posted
IM Bicillin was great for my brain fog and honestly, I feel arrested the Lyme that was really, really fast moving and persistent. I was on it two separate times for months at a time but it seemed the second time- really helped my immune system end up more on top-- which is necessary to get better.
God speed.
Posts: 859 | From Southeast | Registered: Mar 2011
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