IM Rocephin As An Alternative To Bicillin

lyme disease medicine Apr 09, 2018

For those of you who follow my blog for general health and nutrition tips, then I apologize in advance for today’s post. Today I am posting about a very specifically Lyme-related topic, and one about medications at that! But it’s important information to write about, given so many people are struggling to get adequate and appropriate treatment for a very debilitating, chronic condition. I’ve been doing some looking into IM Rocephin as an alternative to Bicillin and have got some encouraging information so far.

In antibiotic treatment for chronic Lyme, we want to ensure a couple of things are happening. One is that there are sufficient antibiotics to address the spirochete, cell-wall deficient and cyst forms of the Borrelia bacteria. The other is that we have medications that cross the blood-brain barrier effectively enough to overcome the persistent neurological symptoms.

Some people end up on intravenous (IV) antibiotics. We know the most commonly used IV medication, Rocephin (ceftriaxone), has good blood-brain barrier medication. The problem is that not everyone can access IV antibiotics, having a PICC line is very invasive and comes with risks of its own, and insurance doesn’t always want to pay for it.

I use a lot of intramuscular (IM) Bicillin in my practice as an alternative – firstly, because as an ND, IV antibiotics are not in my scope of practice, and there are precious few docs where I live that I can refer to for that. Secondly, I have found Bicillin to be very effective. It’s long-acting penicillin given twice weekly, and for many patients, this is the medication that “gave them their brain back”.

So that’s great for those who can get it. But I’m finding that increasingly insurance is knocking it back, and it’s expensive out-of-pocket, usually prohibitively so. Then we have those who are allergic to penicillin so that’s a rule out for them right off the bat (although to be fair I’ve had numerous patients who were told they were allergic to penicillin because they once had a rash as a child, who now can tolerate Bicillin just fine. My rule of thumb is that if there were ever respiratory symptoms, difficulty breathing, tongue or throat swelling etc, we simply don’t risk it; if it was a rash that went away with a dose of Benadryl, the benefit of Bicillin may be worth trying, at a low dose, with Benadryl on hand, or else testing for penicillin allergy be done. But I digress.)

Then I started thinking about Rocephin as a possibility – I knew it could be given IM, but I just haven’t used it that way in my patients, because until now Bicillin was not as costly and more accessible. I reached out to my trusty email list of ILADS docs (International Lyme and Associated Diseases Society) and asked what they thought and if any of them used Rocephin intramuscularly.

The feedback I got was mostly good. The hard part is that while Bicillin is long-acting and can be given twice weekly, Rocephin is not and is therefore typically given at a dose of 2 grams daily. In IV treatment it is often pulsed, 2 grams twice daily 5 days on/ 2 days off. So that means a shot in the bum every day. And I’m told it’s painful. But then Lyme is painful too, right? So I guess it’s a question of picking the evils.

The good news is that it can be safe and effective to use that way; insurance often covers it and/or it’s less expensive. A quick check of, a website that shows the best prices in a local area for medications, showed 1 vial of 2 gram strength was $5-6 depending on the pharmacy. It may also be a good option for people with the penicillin allergy who simply can’t use Bicillin.

As I said, I have not had much experience with IM Rocephin, but I trust my ILADS group – they are the docs with years of cumulative experience treating chronic Lyme – and we all learn from one another. It’s something I’m going to consider from here forward.

My lack of ability to get Bicillin covered for patients is an ongoing frustration for both them and me, so I’m hoping that IM Rocephin might provide a good alternative for a spirochete medication that has great blood-brain barrier penetration. I love it when patients tell me they’re getting their brain back, migraines are resolving and other neurological complaints are improving, so I’m for any treatment that is safe and effective (good risk/benefit ratio), doesn’t mess with their gut, and can provide accelerated relief and healing from this unrelenting illness of chronic Lyme.