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» LymeNet Flash » Questions and Discussion » Medical Questions » Single dose Doxycycline for a new tick bite

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Author Topic: Single dose Doxycycline for a new tick bite
Annelet
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Our municipality has recently been categorized as being "endemic" for Lyme, with 30% of the ticks having the Lyme bacteria. The local doctors will be advised to give a single dose of 200mg Doxycycline for a tick that has been attached for 36 hours or more.

Does anyone know which study(s) the Health Authorities use to defend this proposition of a single dose ?

Posts: 250 | From canada | Registered: Oct 2007  |  IP: Logged | Report this post to a Moderator
sixgoofykids
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I doubt there is a study. That's terrible.

--------------------
sixgoofykids.blogspot.com

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me
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Wow. I'm appalled. I also doubt there is a study. And if so, I would say it's propoganda and invalid.
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gz
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That was the standard presented to me two years ago when I first presented my suspicion of chronic Lyme along with a new bite to my PCP.

Wasn't there a study or something on this that ended up showing that the single dose may have been enough to prevent the formation of an em rash? So the false conclusion was that the dose was preventative. This, despite there being no long term follow ups, not all strains produce em rash, and not all rashes mean illness from Lyme.

It may have been mentioned by Weintraub or Dr. H in book lit, but I really can't remember where I read it.

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TF
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See the exerpts below from "Cure Unknown" by Pam Weintraub. If the book has footnotes, that may give you the answer you are searching for.


p. 342 tells how Ben Luft, infectious disease specialist and Daniel Dykhuizen, evolutionary biologist, working together at Stony Brook went out into the field collecting ticks and analyzing Borrelia. A few years later, they had a graduate student travel the Eastern seaboard as far north as New Hampshire and south through the Carolinas collecting ticks infected with B. burgdorferi spirochetes.

p.343 "The Borrelia were duly isolated and compared for differences in their genes.

Eventually the researchers focused on twenty strains, each with a different version of the changeable OspC. Working with those twenty strains, Luft learned that six didn't infect humans and ten caused only a rash.

Only four of the twenty could leave the skin to invade other tissue like the heart and joints or the brain. The most virulent of the strains turned out to be the prototypical B31, the version of B. burgdorferi" ultimately isolated by Burgdorfer and Barbour at the Rocky Mountain labs in 1981.

The implications are profound. One of the most important is that if just four strains of the twenty cause disseminated infection, then the roster of rash-based studies on the treatment of early Lyme disease, conducted from the 1980s to the present, would have to be reassessed.

Take a moment to ponder the simple math: It would be impossible to accept results based on the assumption that 100 percent of Lyme rashes can cause invasive disease when a significant percent cannot.

Some of the classic studies claim very high cure rates for early infection; yet if the causative strain were of the rash-only variety, then even orange juice would be a "cure." Are recommended treatment protocols truly curing most of those with early, invasive borreliosis? Or has noise from rash-only strains obscured less rosy results? (p. 344)

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Robin123
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That's as good as one swallow of water if you're thirsty...
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Tincup
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One dose of doxy doesn't work. Here is a study refuting the original study.
https://sites.google.com/site/marylandlyme/treatment/one-dose-doxy-doesn-t-work

You can find the full "single dose" protocol in the 2006 IDSA Lyme disease guidelines.

IDSA
 &
 Johns
 Hopkins falsely states- 
 
"Treatment
 of
 tick
 bite
 with
 200
mg
 of
 oral
 doxycycline
 was
 87%
 effective
 in
 preventing
 Lyme
 disease
 in
 tick‐bite
 victims."


Here is one study used to support the IDSA/Hopkins inaccurate statement.


Prophylaxis
 with
 single­ dose
 doxycycline
 for 
the
 prevention
 of
Lyme 
disease 
after
 an 
Ixodes
 scapularis
 tick 
bite. N.
Engl.
J.
Med.
345,
79–84).

 Nadelman,
R.B.,
Nowakowski,
J.,
Fish,
D.,
Falco,
R.C.,
Freeman,
K., 
McKenna,
D.,
Welch,
P., 
Marcus,
R.,
 Agúero‐Rosenfeld,
 M.E.,
 Dennis,
 D.T.,
 Wormser,
 G.P.,
 2001.


Here is one of our submissions that cite the original false statements and explains why the one dose theory is inaccurate.
https://sites.google.com/site/marylandlyme/idsa-panel-review/challenge-one-pill-cures

To fight this policy, here are the latest guidelines by ILADS which specifically address the one dose doxy situation and recommend against it.
https://sites.google.com/site/marylandlyme/treatment

If you need to fight it (and I think you should) you can share the "Treat The Bite" website with everyone.

www.TreatTheBite.com

It has a one page printable handout that everyone can take with them to their doctor with the correct treatment protocols. One is for adults, and one for children.

You can also tell doctors you are not going to be subjected to an unsuccessful protocol from 10 year old guidelines that have been discredited by the CT Attorney General Richard Blumenthal (currently US Senator). You wouldn't expect to be forced to use 10 year old guidelines for a cancer patient and you aren't using them for tick bites and tick diseases.

The IDSA guidelines have been pulled from the National Guidelines Clearinghouse by the federal Dept of Health & Human Services for being outdated (5 years is deemed too old) and NOT complying with minimal standards set forth by the national Institute of Medicine.

Bottom line- the "one dose of doxy theory" has been disproven and the guidelines they were in are outdated by 10 or more years and not considered valid.

--------------------
www.TreatTheBite.com
www.DrJonesKids.org
www.MarylandLyme.org
www.LymeDoc.org

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Lymetoo
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RELIABLE information on Lyme:

http://flash.lymenet.org/ubb/ultimatebb.php/topic/1/88555

--------------------
--Lymetutu--
Opinions, not medical advice!

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'Kete-tracker
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There IS no such study. In fact, the single dose thing's being dropped by all the local health care centers around here. Just not sufficient treatment.

As for 36 hours of attachment needed to be at significant risk for Lyme, I've never heard of such a long period being chosen. Even the IDSA speaks of 24 hours of attachment needed to pass on the disease... which is hogwash, of course. The deer ticks that got me were on for 21 hours at most & one was engorged 'real good'.

And Dr. Burrascano's guidelines indicate there are documented cases of Lyme being contracted with as little as 4 to 6 hours of tick attachment!

You wrote, "the doctors will be advised..." WHO is doing the 'advising'? Clearly this health official needs to study up more.

Oh, & a "Lyme-endemic area" has generally been known as being defined as one where 50% (or more) of the the local [Ixodes genus] ticks have been tested as + for Borrelia Burgderfori.

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Tincup
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Anne said.. "Does anyone know which study(s) the Health Authorities use to defend this proposition of a single dose ?"

Unfortunately, folks keep responding and saying there is NO study, when yes, actually there are studies. A number of them were used by the IDSA to develop their "one dose doxy" treatment protocol. Some are listed below.

N Engl J Med. 2001 Jul 12;345(2):79-84.
Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite.
Nadelman RB1, Nowakowski J, Fish D, Falco RC, Freeman K, McKenna D, Welch P, Marcus R, Agüero-Rosenfeld ME, Dennis DT, Wormser GP; Tick Bite Study Group.
Author information

1Department of Medicine, New York Medical College, Valhalla 10595, USA.
Abstract
BACKGROUND:
It is unclear whether antimicrobial treatment after an Ixodes scapularis tick bite will prevent Lyme disease.
METHODS:
In an area of New York where Lyme disease is hyperendemic we conducted a randomized, double-blind, placebo-controlled trial of treatment with a single 200-mg dose of doxycycline in 482 subjects who had removed attached I. scapularis ticks from their bodies within the previous 72 hours. At base line, three weeks, and six weeks, subjects were interviewed and examined, and serum antibody tests were performed, along with blood cultures for Borrelia burgdorferi. Entomologists confirmed the species of the ticks and classified them according to sex, stage, and degree of engorgement.

RESULTS:
Erythema migrans developed at the site of the tick bite in a significantly smaller proportion of the subjects in the doxycycline group than of those in the placebo group (1 of 235 subjects [0.4 percent] vs. 8 of 247 subjects [3.2 percent], P0.04). The efficacy of treatment was 87 percent (95 percent confidence interval, 25 to 98 percent). Objective extracutaneous signs of Lyme disease did not develop in any subject, and there were no asymptomatic seroconversions. Treatment with doxycycline was associated with more frequent adverse effects (in 30.1 percent of subjects, as compared with 11.1 percent of those assigned to placebo; P0.001), primarily nausea (15.4 percent vs. 2.6 percent) and vomiting (5.8 percent vs. 1.3 percent). Erythema migrans developed more frequently after untreated bites from nymphal ticks than after bites from adult female ticks (8 of 142 bites [5.6 percent] vs. 0 of 97 bites [0 percent], P=0.02) and particularly after bites from nymphal ticks that were at least partially engorged with blood (8 of 81 bites [9.9 percent], as compared with 0 of 59 bites from unfed, or flat, nymphal ticks [0 percent]; P=0.02).

CONCLUSIONS:
A single 200-mg dose of doxycycline given within 72 hours after an I. scapularis tick bite can prevent the development of Lyme disease.

Link Here- http://www.ncbi.nlm.nih.gov/pubmed/11450675


````````````````````````````````````````````````````````````````````````````````````````````````

N Engl J Med. 1992 Dec 17;327(25):1769-73.
A controlled trial of antimicrobial prophylaxis for Lyme disease after deer-tick bites.
Shapiro ED1, Gerber MA, Holabird NB, Berg AT, Feder HM Jr, Bell GL, Rys PN, Persing DH.
Author information

1Department of Pediatrics, Yale University School of Medicine, New Haven, Conn. 06510-8064.
Abstract

BACKGROUND:
Borrelia burgdorferi, which causes Lyme disease, is transmitted by deer ticks (lxodes dammini) in the northeastern and midwestern United States. Although deer-tick bites are common in areas in which the disease is endemic, there is uncertainty about how to manage the care of persons who are bitten.

METHODS:
To assess the risk of infection with B. burgdorferi and the efficacy of prophylactic antimicrobial treatment after a deer-tick bite, we conducted a double-blind, placebo-controlled trial in an area of southeastern Connecticut in which Lymedisease is endemic. Children and adults who had been bitten by deer ticks were randomly assigned to receive either amoxicillin or placebo for 10 days. Subjects were followed for one year for clinical manifestations of Lyme disease. Serum samples obtained at enrollment and six weeks and three months later were tested for antibodies against B. burgdorferi.

RESULTS:
Of the 387 subjects, 205 (53 percent) were assigned to receive amoxicillin and 182 (47 percent) to receive placebo. Of 344 deer ticks submitted and analyzed by the polymerase chain reaction, 15 percent were infected with B. burgdorferi. Erythema migrans developed in two subjects, both of whom had received placebo. There were no asymptomatic seroconversions and no late manifestations of Lyme disease. The risk of infection with B. burgdorferi in the placebo-treated subjects was 1.2 percent (95 percent confidence interval, 0.1 to 4.1 percent), which was not significantly different (P = 0.22) from the risk in the amoxicillin-treated subjects (0 percent; 95 percent confidence interval, 0 to 1.5 percent).

CONCLUSIONS:
Even in an area in which Lyme disease is endemic, the risk of infection with B. burgdorferi after a recognized deer-tick bite is so low that prophylactic antimicrobial treatment is not routinely indicated.

Link Here- http://www.ncbi.nlm.nih.gov/pubmed/1435930

`````````````````````````````````````````````````````````
J Gen Intern Med. 1996 Jun;11(6):329-33.
Efficacy of antibiotic prophylaxis for prevention of Lyme disease.
Warshafsky S1, Nowakowski J, Nadelman RB, Kamer RS, Peterson SJ, Wormser GP.
Author information

1Department of Medicine, New York Medical College, Valhalia 10595, USA.
Abstract

OBJECTIVE:
To determine if antibiotic prophylaxis following a dear tick bite is effective in reducing the risk of developing Lyme disease.

DESIGN:
Meta-analysis of published trials.

DATA IDENTIFICATION:
Clinical trials were identified by a computerised literature search of MEDLINE and by an assessment of the bibliographies of published studies.

STUDY SELECTION:
Trials were included in the analysis if their patients were randomly allocated to a treatment or control group, enrolled within 72 hours following an Ixodes tick bite, and had no clinical evidence of Lyme disease at enrollment. Three trials were selected for review after inclusion criteria were applied.

DATA EXTRACTION:
Data were extracted for details of study design, patient characteristics, interventions, duration of therapy, and number of adverse events in each arm of therapy.

RESULTS OF DATA SYNTHESIS:
Among the 600 patients with Ixodes tick bites, the rate of infection in the placebo group was 1.4%. In contrast, patients who received antibiotic prophylaxis had a 0% infection rate. The pooled odds ratio, comparing prophylaxis to placebo, was 0.0 (95% confidence interval 0.0, 1.5) (p = .12).

CONCLUSIONS:
The available evidence to date suggests that the routine use of antibiotic prophylaxis for the prevention of Lyme disease remains uncertain. Meta-analysis of the controlled trials failed to establish definitive treatment efficacy owing to the small sample size of the combined trials and the low rates of infection following a deer tick bite. A larger randomized trial is needed to demonstrate definitively that prophylaxis is more effective than placebo in reducing the risk of early Lymedisease in endemic areas.

Link Here- http://www.ncbi.nlm.nih.gov/pubmed/8803738

````````````````````````````````````````````````````````

Nadelman RB, Nowakowski J, Fish D, et al. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med 2001; 345:79–84.

Costello CM, Steere AC, Pinkerton RE, Feder HM Jr. A prospective study of tick bites in an endemic area for Lyme disease. J Infect Dis 1989; 159:136–9.

Shapiro ED, Gerber MA, Holabird ND, et al. A controlled trial of antimicrobial prophylaxis for Lyme disease after deer-tick bites. N Engl J Med 1992;327:1769–73.

Agre F, Schwartz R. The value of early treatment of deer tick bite for the prevention of Lyme disease. Am J Dis Child 1993; 147:945–7.

Warshafsky S, Nowakowski J, Nadelman RB, Kamer RS, Peterson SJ, Wormser GP. Efficacy of antibiotic prophylaxis for prevention of Lyme disease: a meta-analysis. J Gen Intern Med 1996; 11:329–33.

Takafuji ET, Kirkpatrick JW, Miller RN, et al. An efficacy trial of doxycycline chemoprophylaxis against leptospirosis. N Engl J Med 1984; 310:497–500.

Zeidner NS, Brandt KS, Dadey E, Dolan MC, Happ C, Piesman J. Sustained-release formulation of doxycycline hyclate for prophylaxis of tick bite infection in a murine model of Lyme borreliosis. Anti- microb Agents Chemother 2004; 48:2697–9.

Lee J, Nowakowski J, Nadelman RB, Wormser GP. What amoxicillin regimen is predicted to be equivalent to a single 200 mg oral dose of doxycycline for prevention of Lyme borreliosis [abstract P208]? In: Program and abstracts of the 10th International Conference on Lyme Borreliosis and Other Tick-borne Diseases (Vienna, Austria). Austrian Society for Hygeine, Microbiology, and Preventive Medicine, 2005: 122.

MagidD,SchwartzB,CraftJ,SchwartzJS. PreventionofLymedisease after tick bites—a cost effectiveness analysis. N Engl J Med 1992; 327: 534–41.

Nowakowski J, Wormser GP. Treatment of early Lyme disease: infec- tion associated with erythema migrans. In: Coyle PPK, ed. Lyme disease. St. Louis: Mosby-Year Book, 1993:149–62.

Hunfeld K-P, Kraiczy P, Kekoukh E, Schafer V, Brade V. Standardized in vitro susceptibility testing of Borrelia burgdorferi against well- known and newly developed antimicrobial agents—possible implications for new therapeutic approaches to Lyme disease. Int J Med Microbiol 2002; 291(Suppl 33):125–37

Dattwyler RJ, Volkman DJ, Conaty SM, Platkin SP, Luft BJ. Amox- icillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet 1990; 336:1404–6.

Massarotti EM, Luger SW, Rahn DW, et al. Treatment of early Lyme disease. Am J Med 1992; 92:396–403.

Luft BJ, Dattwyler RJ, Johnson RC, et al. Azithromycin compared with amoxicillin in the treatment of erythema migrans: a double blind, randomized, controlled trial. Ann Intern Med 1996; 124:785–91

Maraspin V, Lotric-Furlan S, Strle F. Development of erythema mig- rans in spite of treatment with antibiotics after a tick bite. Wien Klin Wochenchr 2002; 114:616–9.

--------------------
www.TreatTheBite.com
www.DrJonesKids.org
www.MarylandLyme.org
www.LymeDoc.org

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Tincup
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"The prevalence of B. burgdorferi in nymphal I. scapularis ticks commonly ranges between 20% and 40% in areas of endemicity in the Northeastern and upper Midwestern United States [54– 56]. "

--------------------
www.TreatTheBite.com
www.DrJonesKids.org
www.MarylandLyme.org
www.LymeDoc.org

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Tincup
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Sorry- LN is messing up again. Keeps removing posts after posted, then duplicating them. UG!

--------------------
www.TreatTheBite.com
www.DrJonesKids.org
www.MarylandLyme.org
www.LymeDoc.org

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Tincup
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Kete,

Another quote that may interest you...

"In the single-dose doxycycline chemoprophylaxis trial, duration of tick attachment as assessed by this measure cor- related directly with risk of developing Lyme disease.

Erythema migrans developed at the tick bite site in 8 (9.9%) of 81 placebo- treated subjects bitten by an I. scapularis nymphal tick that had at least some blood engorgement.

The risk increased to 3 (25%) of 12 if the tick were highly engorged, equating to a 􏰁72-h duration of attachment, compared with 0 (0%) of 59 for bites from nymphal ticks with no blood engorgement (P p .02 and P p .004, respectively) [30].

In a separate study from New York State, the risk of developing B. burgdorferi infection was 20% (3 of 15) among patients bitten by highly engorged nymphal or adult-stage I. scapularis ticks that were estimated to have been attached for 􏰁72 h [68]."

This is also from the IDSA guidelines.

--------------------
www.TreatTheBite.com
www.DrJonesKids.org
www.MarylandLyme.org
www.LymeDoc.org

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Tincup
Honored Contributor (10K+ posts)
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Dr. L in NY did an excellent job responding to one of the idiot studies. Anne may want to use this information in Canada for their fight.

He basically says not treating a tick bite is like playing Russian roulette.

http://www.nejm.org/doi/pdf/10.1056/NEJM199002153220714

Of course Bumsteere came back and slobbered all over his response and dropped a cow patty on others, but his response is garbage and need not be shared when making your point.

Talk about cow patty... this might make you smile. Keep in mind it takes place in our own TuTu's favorite place to listen to music. (And we wonder why she seems a bit weird and drops her drawers all the time for the whole world to see?)

https://www.youtube.com/watch?v=OpapdB-bCFI

[lol]

--------------------
www.TreatTheBite.com
www.DrJonesKids.org
www.MarylandLyme.org
www.LymeDoc.org

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