{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:48:36Z","timestamp":1777337316736,"version":"3.51.4"},"reference-count":252,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,4,30]],"date-time":"2024-04-30T00:00:00Z","timestamp":1714435200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MSIDS Research Foundation (MRF)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Three patients with relapsing and remitting borreliosis, babesiosis, and bartonellosis, despite extended anti-infective therapy, were prescribed double-dose dapsone combination therapy (DDDCT) for 8 weeks, followed by one or several two-week courses of pulsed high-dose dapsone combination therapy (HDDCT). We discuss these patients\u2019 cases to illustrate three important variables required for long-term remission. First, diagnosing and treating active co-infections, including Babesia and Bartonella were important. Babesia required rotations of multiple anti-malarial drug combinations and herbal therapies, and Bartonella required one or several 6-day HDDCT pulses to achieve clinical remission. Second, all prior oral, intramuscular (IM), and\/or intravenous (IV) antibiotics used for chronic Lyme disease (CLD)\/post-treatment Lyme disease syndrome (PTLDS), irrespective of the length of administration, were inferior in efficacy to short-term pulsed biofilm\/persister drug combination therapy i.e., dapsone, rifampin, methylene blue, and pyrazinamide, which improved resistant fatigue, pain, headaches, insomnia, and neuropsychiatric symptoms. Lastly, addressing multiple factors on the 16-point multiple systemic infectious disease syndrome (MSIDS) model was important in achieving remission. In conclusion, DDDCT with one or several 6\u20137-day pulses of HDDCT, while addressing abnormalities on the 16-point MSIDS map, could represent a novel effective clinical and anti-infective strategy in CLD\/PTLDS and associated co-infections including Bartonella.<\/jats:p>","DOI":"10.3390\/microorganisms12050909","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T11:39:42Z","timestamp":1714649982000},"page":"909","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Combining Double-Dose and High-Dose Pulsed Dapsone Combination Therapy for Chronic Lyme Disease\/Post-Treatment Lyme Disease Syndrome and Co-Infections, Including Bartonella: A Report of 3 Cases and a Literature Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4952-883X","authenticated-orcid":false,"given":"Richard I.","family":"Horowitz","sequence":"first","affiliation":[{"name":"New York State Department of Health Tick-Borne Working Group, Albany, NY 12224, USA"},{"name":"Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Fallon","sequence":"additional","affiliation":[{"name":"Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0482-8660","authenticated-orcid":false,"given":"Phyllis R.","family":"Freeman","sequence":"additional","affiliation":[{"name":"Hudson Valley Healing Arts Center, Hyde Park, NY 12538, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e007744","DOI":"10.1136\/bmjgh-2021-007744","article-title":"Global Seroprevalence and Sociodemographic Characteristics of Borrelia Burgdorferi Sensu Lato in Human Populations: A Systematic Review and Meta-Analysis","volume":"7","author":"Dong","year":"2022","journal-title":"BMJ Glob. 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