I found this study by accident while looking for something else the other day
https://journals.lww.com/imd/fulltext/2022/09000/nitroxoline_drug_combinations_are_more_active_than.7.aspxit comes from Zhang’s group in Johns Hopkins - who have published many useful papers on antimicrobials for borrelia, bartonella and babesia in prominent journals in recent years
It evaluated antibiotic combinations for borrelia that included nitroxoline
Nitroxoline is an antibiotic that is approved around the world and has been used for 40 years in Europe with an excellent safety record - no serious adverse effects occurred in its original safety trials and in post launch monitoring adverse effects are at less than 1% - which is better than most antibiotics in use today - but is not currently FDA approved (likely for reasons of economics, patents or other competing interests than on any medical basis)
The points that were interesting to me were:
• Nitroxoline on its own was more effective against borrelia than the current best single drug - cefuroxime
• A combination of nitroxoline, cefuroxime and clarithromycin was as effective as 3 drug combinations with Daptomycin when used against stationary phase cultures of borrelia - see figure 2 –
o Note 1 – Daptomycin was quite big news a few years ago - as three drug antibiotic combinations with daptomycin have been found to be one of the only antibiotic combinations to date that can actually eradicate borrelia in the test tube.
o Note 2 - stationary phase cultures represent the slow growing persister states of bacteria present in biofilms consisting of a high proportion of persister cells – persister cells are one of if not the main mechanism that causes borrelia infections to be so hard to treat – because they are pretty much immune to normal antibiotics.
• Daptomycin combinations have been known to be active for persister forms of borrelia for some time – but the daptomycin itself is an IV only drug – is hard to obtain – and only officially approved for certain MRSA infections - so its practical use in Lyme disease is severely restricted at present.
• Whereas Clarithromycin and Cefuroxime and Nitroxoline are all oral antibiotics with good safety records - no IV required. They are also all are freely available as generics at low cost
• Further – a previous study from Zhang’s group identified nitroxoline was also one of the very promising antibiotic agents with much higher activity against bartonella compared to commonly used bartonella antibiotics like rifampicin or clarithromycin – including against stationary phase bartonella cultures
Given such a large proportion of people with hard-to-treat chronic lyme also seem to have bartonella infections - a drug that could target both effectively, including their persister forms, while being low cost and suitable for oral administration would seem to be extremely helpful
Final note – these are in-vitro studies – we really need animal model studies and ideally human studies of these drug combinations- but due to the huge expense of these type of study – and the stigma still attached to lyme disease in general – we could be waiting a long time for these to happen
I didn’t find studies on the activities of Nitroxoline on Babesia – but it does have antiparasitic activity against other protozoans – and is related to compounds which are known to be active for babesia – so it’s possible – likely even - that it has useful effects there also