title: Co-administration of α-lipoic acid and glutathione is associated with no significant changes in serum bilirubin, alkaline phosphatase or γ-glutamyltranspeptidase levels during the treatment of neuroborreliosis with intravenous ceftriaxone.
abstract: BACKGROUND
  While pharmacotherapy with intravenous ceftriaxone, a third-generation cephalosporin, is a potential treatment of Lyme neuroborreliosis, there is concern that it can cause the formation of biliary sludge, leading to hepatobiliary complications such as biliary colic, jaundice and cholelithiasis, which are reflected in changes in serum levels of bilirubin and markers of cholestatic liver injury (alkaline phosphatase and γ-glutamyltranspeptidase). It has been suggested that the naturally occurring substances α-lipoic acid and glutathione may be helpful in preventing hepatic disease. α-Lipoic acid exhibits antioxidant, anti-inflammatory and anti-apoptotic activities in the liver, while glutathione serves as a sulfhydryl buffer. The aim of this study was to determine whether co-administration of α-lipoic acid and glutathione is associated with significant changes in serum levels of bilirubin, alkaline phosphatase and γ-glutamyltranspeptidase during the treatment of Lyme neuroborreliosis with long-term intravenous ceftriaxone.
  
  
  METHODS
  Serum levels of bilirubin, alkaline phosphatase and γ-glutamyltranspeptidase were measured in 42 serologically positive Lyme neuroborreliosis patients before and after long-term treatment with intravenous ceftriaxone (2-4 g daily) with co-administration of oral/intravenous α-lipoic acid (600 mg daily) and glutathione (100 mg orally or 0.6-2.4 g intravenously daily).
  
  
  RESULTS
  None of the patients developed biliary colic and there were no significant changes in serum bilirubin, alkaline phosphatase or γ-glutamyltranspeptidase levels over the course of the intravenous ceftriaxone treatment (mean length 75.0 days).
  
  
  CONCLUSIONS
  Co-administration of α-lipoic acid and glutathione is associated with no significant changes in serum bilirubin, alkaline phosphatase or γ-glutamyltranspeptidase levels during the treatment of neuroborreliosis with intravenous ceftriaxone.
authors.forename: Basant K
authors.initials: BK
authors.lastname: Puri
authors.forename: Jaana S
authors.initials: JS
authors.lastname: Hakkarainen-Smith
authors.forename: Anne
authors.initials: A
authors.lastname: Derham
authors.forename: Jean A
authors.initials: JA
authors.lastname: Monro
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001663:Bilirubin / Q000097:blood; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000517:prevention & control*; D015331:Cohort Studies; D005260:Female; D005978:Glutathione / Q000008:administration & dosage*; D006801:Humans; D020852:Lyme Neuroborreliosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D008063:Thioctic Acid / Q000008:administration & dosage*; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D000900:Anti-Bacterial Agents; D008063:Thioctic Acid; D002443:Ceftriaxone; D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D005978:Glutathione; D001663:Bilirubin