Lyme disease, caused by Borrelia burgdorferi, is one of most common vector-borne diseases. It is estimated that over 470,000 people are diagnosed and treated for the disease each year in the United States, based on insurance claims data (2010-2018). Several in vitro studies show that B. burgdorferi forms drug-tolerant persisters when treated with antibiotics. Approximately 10-20% of patients treated with antibiotics can develop a condition called post-treatment Lyme disease syndrome, characterized by muscle and joint pain, psychosocial and cognitive difficulties, and fatigue. The complex “stealth’ pathology of B. burgdorferi allows the spirochete to invade diverse tissues, elude the immune response, and establish long-term infection.
Researchers at Stanford School of Medicine screened 7450 chemicals with potential utility for B. burgdorferi. They found that Azlocillin could inhibit late log phase and 7-10 day old stationary phase cultures of the pathogen. Along with Azlocillin, Cefotaxime inhibited doxycycline-tolerant B .burgdorferi in vitro in efficacy studies on drug-tolerant persisters using semisolid plating methods. The combination of Azlocillin and Cefotaxime was also effective against persisters. In vivo, Azlocillin has shown efficacy against B. burgdorferi sensu stricto JLB31 in mice models.
Relatively little is known about the in vivo pharmacodynamic interactions of antimicrobial agents with Borelliae. Further characterization of the susceptibility pattern and a better understanding of the interaction of B. burgdorferi with antimicrobial agents is needed for Lyme disease therapies.
References
Hunfeld K (2002) Standardised in vitro susceptibility testing of Borrelia burgdorferi against well-known and newly developed antimicrobial agents- Possible implications for new therapeutic approaches to Lyme disease. Int. J. Med. Mirobiol. 291. Suppl. 33:125-137 PMID 12141737
Pothineni et al (2020) Azlocilin can be the potential drug candidate against drug-tolerance Borrelia burgdorferi sensu stricto JLB31. Sci. Rep. 10(1):3798 PMID 32123189
Pothineni VR et al (2016) Identification of new drug candidates against Borrelia burgdorferi using high-throughput screening. Drug design, development and therapy vol. 10 1307-22 PMID 27103785
Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Division of Vector-Borne Diseases (DVBD) Jan 2021 "How many people get Lyme disease'. Link.