Was originally found on http://fit.gmd.de/~roh/LymeInfo/Metronidazole.html


presented on the


April 1999, New York City/New Jersey, USA

Dr. Martin Atkinson-Barr CPhys PhD (Calabasas, CA) and Dr. Vernon Padgett MD (Calabasas, CA) together with Dr. Richard Horowitz MD (Hyde Park, NY)



Borrelia burgdorferi has been shown to be capable of persisiting in human hosts despite extensive antibiotic treatment (Preac-Mursic V, et al: Survival of Bb in antibiotically treated patients with Lyme Borreliosis, Infection 1989; 17: 355-359). Persistent illness is due to a combination of factors including sequestration in antibiotic and immunologically privileged sites(Luft et al: Invasion of the CNS by BB in acute disseminated infection, JAMA 1992; 267: 1364-1367 ). This report describes the use of Metronidazole (Flagyl) in a cohort of chronic Lyme patients resistant to standard antibiotic regimens.


57 patients with Lyme disease, and/or Ehrlichiosis and Babesiosis were previously treated with either oral, IM or IV regimens prior to being started on metronidazole. Flagyl was given at a dose of 250mg TID for the 1st week irrespective of body weight, and patients between 121-150 lbs had their dose increased at the 2nd week to 1000mg/day, with patients greater than 150 lbs. increased to 1500 mg/day for the next month. Dosages were decreased or temporarily stopped and restarted for severe Jarish-Herxheimer type flares, or for increased paresthesiasis of the extremeties. Most patients took Flagyl alone, but several patients added it to their prior antibiotic regimens if they had shown no further improvement of symptoms. Patients filled out a Karnofsky performance scale before and after treatment, and were monitored with a CBC and liver function testing at the completion of therapy.


Jarish-Herxheimer type flares were common during the 1st few weeks of treatment (32/57 patients). 47% of patients reported a significant decrease in arthralgias, with joint pain disappearing completely in 5 patients after only 7 days of therapy. Fatigue improved in 19/57 patients (33%) and neurocognitive symptoms improved in 28 patients (49%) including decreased headaches, paresthesias, and improved memory and concentration. Several patients did not show clinical improvement until the Metronidazole was stopped. The median and mean percent improvement by the Karnofsky performance scale was 13% after 1 month of treatment. An additional 26% mean percent improvement was reported among 7 patients completing a 2nd month of treatment.


Flagyl appears to have anti-borrelial activity and its effectiveness has also been documented in human infections with syphillis (Davies AH, Br.J.Vener Dis 1967; 43197-200). Median and mean improvement in Lyme disease patients was 13% at one month, but several patients showed dramatic clinical improvement, and those patients with an inadequate clinical response, often had PCR and RNA evidence of ongoing co-infection with Babesiosis. The clinical effectiveness of Metronidazole may be explained by its high bioavailability, good cellular penetration and tissue distribution with good penetration into CSF, and the formation of redox intermediate metabolites which target the RNA, DNA, or cellular proteins of the micro-organisms irrespective of replication. Further studies need to be done to evaluate the spectrum of Flagyl's role in chronic Lyme-disease.


Last changes at: Tuesday 22.08.2000 10:44