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.
Level 4 - case-series / case-control
Retrospective case series without a control group.
PubMed 37764145 · doi:10.3390/microorganisms11092301
What was done
A retrospective chart review was conducted on 25 patients with relapsing and remitting Borreliosis, Babesiosis, and Bartonellosis despite previous extended anti-infective treatment. Patients were treated with double-dose dapsone combination therapy (DDDCT) followed by one or more courses of high-dose dapsone combination therapy (HDDCT), comparing outcomes between 4-day and 6-7 day pulses.
What was found
All 25 patients (100%) showed improvement in tick-borne symptoms, with 6-7 day pulses demonstrating greater improvement than 4-day pulses when Bartonella co-infection was present. Of the 23 patients who finished 8 weeks of DDDCT followed by 5-7 day HDDCT pulses, 7 (30.5%) stayed in remission for 3 to 9 months, and 3 (13%) were in complete remission at 1.5 months post-treatment.
Why it matters
This small series provides preliminary clinical experience for pulsed high-dose dapsone combinations in persistent, treatment-refractory Lyme disease and associated coinfections.
Limits
The study is limited by a very small sample size (n = 25), a retrospective uncontrolled design, lack of blinding or placebos, potential selection bias, short follow-up duration (1.5 to 9 months), and an absence of standardized objective outcome metrics or safety data in the abstract.
Cited by
- partial A 9-week dapsone antibiotic protocol induces remission in approximately half of patients with chronic Lyme disease who do not have active Babesia, Bartonella, or mold illness.