Antibiotic gel prevents borreliosis resulting from tick bites

Thanks for posting this Dan!

This sounds promising, but I just did a internet search for antibiotic gel azithromycin and nothing came up regarding a product that can be purchased. Is anyone aware of such a product and where to purchase?

A quote from the link, emphasis added:

In addition to the Medical University of Vienna, Austrian partners involved in the Phase II/III study, which now only has to be followed by a verification study in order to be potentially put into clinical use, were the Medical University of Graz (Department of Dermatology), the Medical University of Innsbruck (Department of Dermatology and Venerology), the Elisabethinen Hospital in Linz and the Center for Travel Medicine in St. Pölten. Other study partners come from Germany (Berlin, Würzburg) and Switzerland (Zürich). The antibiotic gel was developed by the Swiss company Ixodes AG

Since I will be in Switzerland in June I will try and get some of the gel..

google found “azithromycin gel”.  Here’s one –

http://retailpharmaindia.com/product/azifast-gel-20-gm/

Haha. You gotta love the internet … the original well-spring of alternative facts. Here is an article that says the azithromycin antibiotic gel does not prevent the disease, but only delays the onset of the rash. Feel free to choose your reality.

http://danielcameronmd.com/azithromycin-gel-fails-to-prevent-lyme-disease/

Christopher here is additional info that relates to your link:

Topical azithromycin for the prevention of Lyme borreliosis: a randomised, placebo-controlled, phase 3 efficacy trial
<h2 class=”sectionTitle”>Summary</h2>
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<h3 class=”sectionTitle”>Background</h3>
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Lyme borreliosis develops in 1–5% of individuals bitten by ticks, but with a diagnostic gap affecting up to 30% of patients, a broadly applicable pharmacological prevention strategy is needed. Topical azithromycin effectively eradicated Borrelia burgdorferi sensu lato from the skin in preclinical studies. We assessed its efficacy in human beings.

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<h3 class=”sectionTitle”>Methods</h3>
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In this randomised, double-blind, placebo-controlled, multicentre trial done in 28 study sites in Germany and Austria, adults were equally assigned to receive topical 10% azithromycin or placebo twice daily for 3 consecutive days, within 72 h of a tick bite being confirmed. Randomisation numbers, which were stratified by study site, were accessed in study centres via an interactive voice-response system, by pharmacists not involved in the study. The primary outcome was the number of treatment failures, defined as erythema migrans, seroconversion, or both, in participants who were seronegative at baseline, had no further tick bites during the study, and had serology results available at 8 weeks (intention-to-treat [ITT] population). This study is registered with EudraCT, number 2011-000117-39.

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<h3 class=”sectionTitle”>Findings</h3>
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Between July 7, 2011, and Dec 3, 2012, 1371 participants were randomly assigned to treatment, of whom 995 were included in the ITT population. The trial was stopped early because an improvement in the primary endpoint in the group receiving azithromycin was not reached. At 8 weeks, 11 (2%) of 505 in the azithromycin group and 11 (2%) of 490 in the placebo group had treatment failure (odds ratio 0·97, 95% CI 0·42–2·26, p=0·47). Topical azithromycin was well tolerated. Similar numbers of patients had adverse events in the two groups (175 [26%] of 505 vs 177 [26%] of 490, p=0·87), and most adverse events were mild.

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<h3 class=”sectionTitle”>Interpretation</h3>
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Topical azithromycin was well tolerated and had a good safety profile. Inclusion of asymptomatic seroconversion into the primary efficacy analysis led to no prevention effect with topical azithromycin. Adequately powered studies assessing only erythema migrans should be considered. A subgroup analysis in this study suggested that topical azithromycin reduces erythema migrans after bites of infected ticks.

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<h3 class=”sectionTitle”>Funding</h3>
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Ixodes AG.

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In a recent study conducted in Germany and Austria, researchers applied a 10% azithromycin gel to the site of a tick bite for 3 days. The trial was stopped early after it failed to prove that the gel worked in preventing Lyme disease (LD) for the 995 subjects. The topical treatment failed to prevent a combination of seroconversion or an EM rash in 11 (2%) of 505 individuals in the azithromycin group and 11 (2%) of 490 participants in the placebo group.
4 REPLIES TO “AZITHROMYCIN GEL FAILS TO PREVENT LYME DISEASE”

Louise Alban 03/07/2017 (2:18 pm) Reply
Thank you for this post, Dr Cameron. This was widely reported in the press as being a trial which showed that the gel had “promise” as a treatment for infected bites. As here: http://www.news-medical.net/news/20161220/Antibiotic-gel-shows-promise-in-preventing-onset-of-Lyme-borreliosis-following-tick-bite.aspx

Dr. Daniel Cameron 03/07/2017 (7:23 pm) Reply
It is a shame the gel failed to work

Yemel Bryan 03/15/2017 (8:05 pm) Reply
Is Azithromycin in tablet form affective to treat Lyme?

Dr. Daniel Cameron 03/15/2017 (8:58 pm) Reply
Oral Zithromax has been effective in most studies. Doxycycline beat Zithromax in on study my Massaroti in 1992.

Topical azithromycin for the prevention of Lyme borreliosis: a randomised, placebo-controlled, phase 3 efficacy trial

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Wow. Don’t believe (lightly rewritten) press releases. This example is one of the worst I’ve ever seen.

PR: “An antibiotic gel based on azithromycin, an antibiotic with antibacterial properties, helps to prevent the onset of Lyme borreliosis following a tick bite.”

Journal article: “The trial was stopped early because an improvement in the primary endpoint in the group receiving azithromycin was not reached.”

— Rex

Look at the dates when the tests were being applied and also the results in percentages:

“Between July 7, 2011, and Dec 3, 2012, 1371 participants were randomly assigned to treatment, of whom 995 were included in the ITT population. The trial was stopped early because an improvement in the primary endpoint in the group receiving azithromycin was not reached. At 8 weeks, 11 (2%) of 505 in the azithromycin group and 11 (2%) of 490 in the placebo group had treatment failure (odds ratio 0·97, 95% CI 0·42–2·26, p=0·47). Topical azithromycin was well tolerated. Similar numbers of patients had adverse events in the two groups (175 [26%] of 505 vs 177 [26%] of 490, p=0·87), and most adverse events were mild.”

Greg, a little research from the link you gave led me to google Azifast  and i found this:

What is Azifast?
Azifast Gel is used for Skin infections, Bacterial infections and other conditions.
Azifast Gel contains Azithromycin as an active ingredient.
Azifast Gel works by stopping the growth of bacteria.

The use of Azifast might prevent development of borreliosis resulting from tick bites. I don’t think it would hurt to carry a tube in a first aid kit.
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Dan, when you mention the percentages keep in mind the rate at which a tick bite results in Lyme is not terribly high. “Up to 5% of all tick bites result in Lyme disease” according to the study pre-research statement.

Now observe that in the realitively small study sample, 2% of the control group AND 2% of the experimental group developed Lyme … meaning both treated and untreated demonstrate identical rates of infection.

And then you have the rate of adverse reactions.

As we can see the study went through 3 phases and was found not worthy of marketing for prevention of Lyme.

Maybe, just maybe, if the gel was applied to the head area of an attached tick prior to removal, maybe, it might be more effective in prevention IF the tick is a carrier of the disease. Can we say “an ounce of prevention is worth a pound of cure”

actually that makes sense

tick mouth goes into your skin

gel would be on the outer surface of skin so wouldn’t get to where the bacteria are

it seems like we’re back to prevention – check for ticks, treat outside of clothing with permethrin

know the symptoms of lyme and get tested if you think you might be infected, do not wait weeks or months because then the disease can be much worse

Antibiotics are antibacterial. In fact, antibiotics only work on bacteria.

lyme disease is caused by a bacteria

I think Sam was referring to this rather redundant turn of words above:

“an antibiotic with antibacterial properties”

All other things being equal, I would like to have an anti bacterial something or other that I could apply to the site of a tick bite in the hope of avoiding the misery of Lyme disease treatment.

You should treat any tick bite like an open wound – clean it well with soap and water, apply antibiotic ointment if you’re into that, and keep it protected.

One tick bite triggered a serious staph infection that swelled up the size of a half grapefruit. The doc I saw said other infections from tick bites are far more common than Lyme in Central California.

I doubt any OTC antibiotic ointment will kill Borellia specifically.

— Rex

I carry Polysporin instead of Neosporin B/C a doctor told me it was a “wider spectrum” antibiotic.

I dunno if it would be efficacious against Lyme disease infection but it can’t hurt.

In that case I’ll carry Polysporin until we find out something better.

More info i found interesting:

Symptoms: Early Stage
Within one to four weeks of being bitten by an infected tick, most people will experience some symptoms of Lyme disease. A circular, expanding rash (called erythema migrans) at the site of the bite develops in about 70%-80% of cases. Some people report flu-like symptoms at this stage, including fever, chills, headaches, fatigue, swollen lymph nodes, joint pain, and muscle aches.

Lyme disease is an infection that is transmitted through the bite of a tick infected with a bacterium called Borrelia burgdorferi. Ticks typically get the bacterium by biting infected animals, like deer and mice. Most people who get tick bites do not get Lyme disease. Not all ticks are infected, and the risk for contracting the disease increases the longer the tick is attached to the body.
http://www.webmd.com/arthritis/ss/slideshow-lyme-disease

Active ingredients in Polysporin and generic “double antibiotic ointment”: Bacitracin and Polymyxin B

Active ingredients in Neosporin and generic “triple antibiotic ointment”: Bacitracin, Polymyxin B, and Neomycin

Adding Neomycin kills more kinds of bacteria, so Neosporin would be considered “wider spectrum.” However, many people are allergic to neomycin.

— Rex

Rex, did they say what the allergic reactions were?

Dan,

According to reputable web sites, a typical allergic reaction to Neomycin is hives – red, raised, itchy bumps, sometimes with swelling. Repeated or prolonged use can make symptoms worse. About 7%-10% of people tested are allergic to Neomycin – and Bacitracin. So both Neosporin and Polysporin could trigger an allergic reaction.

Disclaimer: I am not a doctor, don’t believe everything you read on the Internet, etc.

— Rex

I wonder if the rash could be confused with the Lyme rash : )