Magazine article Drug Topics

Dissension Continues on How to Treat Lyme Disease

Magazine article Drug Topics

Dissension Continues on How to Treat Lyme Disease

Article excerpt

For patients with Lyme disease whose symptoms linger after the active infection has already been treated, continued and prolonged use of antibiotics is not effective and can lead to the development of resistance. This is just one of the new conclusions from the American Academy of Neurology's (AAN) recently issued treatment guideline, Practice Parameter: Treatment of Nervous System Lyme Disease (an evidencebased review). The authors of the document set out to answer three questions: Which antibiotics are effective? Are certain antibiotics preferred in specific situations? What is the optimal duration of treatment?

According to guideline author John J. Halperin, M.D., from Atlantic Health and Overlook Hospital in Summit, N.J., previously existing documents help diagnose and treat general Lyme disease, but there is uncertainty about how to treat neuroborreliosis, in which the Lyme disease-causing bacteria Borrelia burgdorferi affect the nervous system. It occurs in 10% to 15% of cases.

In adults and children, the guidelines state that Lyme disease involving the nervous system responds well to penicillin, ceftriaxone, cefotaxime, and oral doxycycline.

"Notably, the only oral regimen that has been shown to be effective in neuroborreliosis is doxycycline, a drug with good central nervous system [CNS] penetration," the guideline states. Ralph H. Raasch, Pharm.D., FCCP, associate professor of pharmacy at the University of North Carolina College of Pharmacy, agrees. "Doxycyline appears to be as effective as other antibiotics for non-parenchymal disease," he said. "It is reasonably nontoxic, is easy to take [most of the time], and is not expensive. In addition, the drug does achieve adequate concentrations in the central nervous system to promote these positive effects," he added.

Raasch also noted that some experts' experience with doxycycline for treatment of late neurological Lyme disease is not so positive, but the AAN statement derives its conclusions from an adequate strategy of identifying well-done studies to address the use of the drug.

For parenchymal involvement, severe neurologic symptoms, or failure to respond to oral therapy, parenteral antibiotic regimens maybe associated with better outcomes.

The new practice parameter also addresses the issue of post-Lyme syndrome, defined as a combination of chronic symptoms of fatigue, musculoskeletal pain, and neuropsychiatrie symptoms in the absence of laboratory or clinical evidence of focal or inflammatory nervous system involvement. …

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