Comparison of the Efficacy of Longer versus Shorter Pulsed High Dose Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome with Bartonellosis and Associated Coinfections

Abstract

Twenty-five patients with relapsing and remitting Borreliosis, Babesiosis, and bartonellosis despite extended anti-infective therapy were prescribed double-dose dapsone combination therapy (DDDCT), followed by one or several courses of High Dose Dapsone Combination Therapy (HDDCT). A retrospective chart review of these 25 patients undergoing DDDCT therapy and HDDCT demonstrated that 100% improved their tick-borne symptoms, and patients completing 6-7 day pulses of HDDCT had superior levels of improvement versus 4-day pulses if Bartonella was present. At the completion of treatment, 7/23 (30.5%) who completed 8 weeks of DDDCT followed by a 5-7 day pulse of HDDCT remained in remission for 3-9 months, and 3/23 patients (13%) who recently finished treatment were 1 ½ months in full remission. In conclusion, DDDCT followed by 6-7 day pulses of HDDCT could represent a novel, effective anti-infective strategy in chronic Lyme disease/Post Treatment Lyme Disease Syndrome (PTLDS) and associated co-infections, including Bartonella, especially in individuals who have failed standard antibiotic protocols.

Keywords: Lyme disease; babesiosis; bartonellosis; dapsone combination therapy (DDSCT); double-dose dapsone combination therapy (DDDCT); florescent in situ hybridization (FISH); high-dose dapsone combination therapy (HDDCT); persistent infection; post-treatment Lyme disease syndrome (PTLDS).

Figure 1

MSIDS Variables Present Among 25 Patients with CLD/PTLDS on DDDCT/HDDCT.

Figure 2

Bartonella Granulomas Pre and Post HDDCT.

Figure 3

Bartonella striae which emerged one year post DDDCT.