Part 2

The 6 Elements of Antimicrobial Treatment

Part 1 was where I addressed some of the basic, yet crucial aspects of lifestyle modification. If you haven't read that brief article, I encourage you to do so. If treatment with antimicrobials is successful, the ultimate goal is to get off of the meds. At that point, healthy choices and habits will be what sustain you during the remission period. In this article, I want to introduce you to the comprehensive antimicrobial approach that many lyme-literate doctors are using. 

When I started treating Lyme, I was, like most physicians, only using single antibiotics at a time (such as doxycycline) and for limited periods of time (perhaps 30 days). This is certainly an appropriate treatment approach for an acute exposure to the bug (Borrelia burgdorferi), but many patients with long term, chronic symptoms from Lyme Disease require a more broad approach. The problem is that the offending spirochete (again, Borrelia) has been discovered to "hide" in different forms: cystic, intracellular, and cell wall forms. Each of these forms may require a different category of antibiotic in order to effectively target the bug.

Furthermore, many of us have experienced the backlash of yeast infections when taking even short term antibiotics. This is because the microbiome -  or the balance between microorganisms in the body and digestive tract - gets thrown out of whack and the yeast are no longer kept in check by the good bacteria. This is another crucial aspect of treatment to keep in mind. We have to simultaneously kill the Borrelia, keep yeast at bay, and maintain or restore the good bacteria. 

Finally, if morphing into 3 different forms isn't enough of a challenge, Borrelia can create a biofilm. No, this is not a boring movie that your science teacher makes you watch the last week before summer break. Biofilm is a slime that microbes secrete that serves several functions. It is sticky so it enables these microorganisms to adhere to different surfaces. It also serves as a protective layer, insulating the bugs from their environment or even from antibiotics rendering them less effective. A good everyday example of biofilm is the plaque that develops on your teeth at the end of the day. Just as we need to brush our teeth to keep them healthy, to be comprehensive with Lyme treatment, we must address biofilm. 

Let's briefly go through the 6 elements of antimicrobial Lyme therapy. I want to acknowledge Dr. Richard Horowitz who wrote a very comprehensive and informative book entitled Why Can't I Get Better: Solving the Mystery of Lyme & Chronic Disease. Much of the information that I am sharing is also contained in his book. 

The 6 Elements of Antimicrobial Therapy 

1. Target Intercellular Form

 This is the most common form addressed by physicians. Typical meds include doxycycline, minocycline or tetracycline. Azithromycin, ciprofloxacin, and rifampin are other antibiotics that can target this form. 

2. Target Cell Wall Form

The most common antibiotics to target this form include penicillins (such as amoxicillin and penicillin G), and cephalosporins (such as cefuroxime, cefdinir, cefixime, and ceftriaxone).

3. Target Cystic Form

Metronidazole, tinidazole, and plaquenil are effective treatments for the cystic form. Grapefruit seed extract is another "natural" antibiotic that can be effective here as well. 

4. Address Biofilm

Digestive/pancreatic enzymes and oral EDTA are good ways to ensure against biofilm. I most often use a product called Interfase. Nattokinase, Wobenzyme, or high-dose doxycycline can be used as well. 

5. Prevent Yeast Overgrowth

There are many ways to combat yeast. Primarily, avoiding sugar and alcohol will slow any growth of yeast - as yeast love sugar. Nevertheless, I often use grapefruit seed extract, capryllic acid, plant tannins, oregano or olive leaf extract as "natural" antifungals. I have from time to time used nystatin or fluconazole as well. 

6. Restore Good Bacteria

Finally, with all this "anti-microbial" war going on, we have to be sure that we are repopulating the gut with the good guys. I use a variety of probiotics depending on the other factors such as overall gut inflammation, information from stool testing, and patient history. Primarily, you want to make sure you have a wide spectrum of probiotic strains. Be sure yours includes bifidobacter and lactobacillus. The number of colony-forming-units (CFUs) can be important as well. I have used up to 225 billion CFUs, but sometimes 15-30 billion as maintenance. 


If you have Lyme and it has been so debilitating that lifestyle modifications alone are not keeping it under control, you may need to go down this antimicrobial route. Also, keep in mind that if you've been treated with just one antibiotic here or there, you might not be addressing it as thoroughly as necessary. Consider discussing these 6 elements with your doctor. Hopefully, you can get some relief by combining these 6 targeted therapies.

Stay tuned for Part 3 where I will address some other alternative treatments that have made a difference for a number of my Lyme patients without the use of antibiotics.