LYMEPOLICYWONK: Embers Monkey Study Part 3. IDSA 28 Day Treatment Protocol Fails to Clear Infection.
This is Part 3 of a series on the Embers study of Lyme disease in non-human primates. As described in Part 1 of the series, the Embers monkey research study posed three questions: one regarding treatment of early disseminated Lyme disease, one regarding treatment of late disseminated Lyme disease, and one regarding the ability of the C6 to accurately detect infection. This part focuses on the first question–the ability of 28 days of antibiotics to eradicate infection in early disseminated Lyme disease. The 28 day treatment with doxycycline was intended to test the treatment recommendation of the Infectious Diseases Society of America (IDSA). The Embers study found that infection persisted in all monkeys treated with this protocol.
Early disseminated Lyme disease was defined by the researchers as 4 months after inoculation. For this portion of the study, 5 monkeys were inoculated with Borrelia burgdorferi (Bb), 3 were treated with 28 days of doxycycline after 4 months. At about one year after inoculation, the monkeys intensive tissue sampling was conducted to determine whether Bb persisted notwithstanding treatment. The protocol used was the IDSA’s protocol for early Lyme, in this case 28 days of doxycycline. Persistent infection was found in all five animals.
This means that for monkeys that go untreated for 4 months before beginning treatment, persistent infection after 28 days of treatment is expected. There are studies that show that the IDSA short term protocol is successful for many (but not all) patients who are diagnosed and treated with an EM rash. However, this study–which used 4 months as the threshold for determining early disseminated Lyme disease–had a 100% failure rate.
The Embers study suggests that attempting to use EM rash treatment approaches to patients who have had the illness for even a short while longer is not appropriate. And, it suggests that even for early disseminated cases of Lyme disease, alternative more effective treatment options are needed because standard IDSA protocols do not clear infection.
This article is part of a series of reviewing the Embers findings for treatment of chronic and early disseminated Lyme disease as well as the effectiveness of the C6 antibody test. You can find these other posts here:
References for this post:
Embers ME, Barthold SW, Borda JT, Bowers L, Doyle L, Hodzic E, et al. Persistence of Borrelia burgdorferi in Rhesus Macaques following Antibiotic Treatment of Disseminated Infection. PLoS ONE. 2012;7(1):e29914. Available at:http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029914
Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006 Nov 1;43(9):1089-134.