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» LymeNet Flash » Questions and Discussion » Medical Questions » 08 KIDS LYME GUIDELINES by Dr. Burrascano, llmd! 2 pages from his complete guideline

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Author Topic: 08 KIDS LYME GUIDELINES by Dr. Burrascano, llmd! 2 pages from his complete guideline
bettyg
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Dr. Burrascano's most recent "Diagnostic Hints and 2008 Treatment Guidelines for Lyme and Other Tick Borne Illnesses" @

Here's the link to the latest ILAD's guidelines,
please read starting on page 18, in fact I suggest reading the entire document ...

maybe you will actually learn something:

http://www.ilads.org/lyme_disease/treatment_guidelines.html

**********************************
from burrascano's 08 lyme guidelines; page 18...
for CHILDREN!! there may be more; this is what i found at a quick glance thru all the pages!
***********************************************

ANTIBIOTIC CHOICES AND DOSES


ORAL THERAPY: Always check blood levels when using agents marked with an *, and adjust dose to
achieve a peak level above ten and a trough greater than three. Because of this, the doses listed below
may have to be raised. Consider Doxycycline first in early Lyme due to concern for Ehrlichia co-infections.


*Amoxicillin- Adults: 1g q8h plus probenecid 500mg q8h; doses up to 6 grams daily are
often needed

Pregnancy: 1g q6h and adjust.

Children: 50 mg/kg/day divided into q8h doses.

*Doxycycline- Adults: 200 mg bid with food; doses of up to 600 mg daily are often
needed, as doxycycline is only effective at high blood levels.

Not for children or in pregnancy.
***********************************

If levels are too low at tolerated doses, give parenterally or change to another
drug.

*Cefuroxime axetil- Oral alternative that may be effective in amoxicillin and doxycycline
failures. Useful in EM rashes co-infected with common skin pathogens.

Adults and pregnancy: 1g q12h and adjust. Children: 125 to 500 mg q12h
based on weight.

Tetracycline- Adults only, and not in pregnancy. 500 mg tid to qid

Erythromycin- Poor response and not recommended.

Azithromycin- Adults: 500 to 1200 mg/d. Adolescents: 250 to 500 mg/d

Add hydroxychloroquine, 200-400 mg/d, or amantadine 100-200 mg/d

Cannot be used in pregnancy or in younger children.
**********************************************************

Overall, poor results when administered orally

Clarithromycin- Adults: 250 to 500 mg q6h plus hydroxychloroquine, 200-400 mg/d,
or amantadine 100-200 mg/d.

Cannot be used in pregnancy or in younger
children.***************************************

Clinically more effective than azithromycin

Telithromycin- Adolescents and adults: 800 mg once daily
Do not need to use amantadine or hydroxychloroquine
*************************************************************

So far, the most effective drug of this class, and possibly the best oral agent if tolerated. Expect strong and quite prolonged Herxheimer reactions.

Must watch for drug interactions (CYP3A-4 inhibitor), check the QTc interval, and monitor liver enzymes.

Not to be used in pregnancy.
**********************************

*Augmentin- Standard Augmentin cannot exceed three tablets daily due to the clavulanate, thus is given with amoxicillin, so that the total dose of the amoxicillin
component is as listed above for amoxicillin.

This combination can be effective when Bb beta lactamase is felt to be significant.

*Augmentin XR 1000- This is a time-release formulation and thus is a better choice than
standard Augmentin.

Dose- 1000 mg q 8 h, to 2000 mg q 12 h based on blood levels.

Chloramphenicol- Not recommended as not proven and potentially toxic.

Metronidazole: 500 to 1500 mg daily in divided doses. Non-pregnant adults only.
****************************

PARENTERAL THERAPY

Ceftriaxone- Risk of biliary sludging (therefore often Actigall is co-administered- one to three tablets daily).

Adults and pregnancy: 2g q12 h, 4 days in a row each week

This watermark does not appear in the registered version - http://www.clicktoconvert.com

MANAGING LYME DISEASE, 16h edition, October, 2008

Page 19 of 37

Children: 75 mg/kg/day up to 2g/day

Cefotaxime- Comparable efficacy to ceftriaxone; no biliary complications.

Adults and pregnancy: 6g to 12g daily. Can be given q 8 h as divided doses, but a continuous infusion may be more efficacious.

When exceeding 6 g daily, use pulsed-dose schedule

Children: 90 to 180 mg/kg/day dosed q6h (preferred) or q8h, not to exceed 12 g daily.
**********************************

*Doxycycline- Requires central line as is caustic.

Surprisingly effective, probably because blood levels are higher when given parenterally and single large daily doses optimize kinetics of killing with this drug.
Always measure blood levels.

Adults: Start at 400 mg q24h and adjust based on levels.

Cannot be used in pregnancy or in younger children.
**********************************************************

Azithromycin- Requires central line as is caustic.

Dose: 500 to 1000 mg daily in adolescents and adults.

Penicillin G- IV penicillin G is minimally effective and not recommended.
**************************

Benzathine penicillin- Surprisingly effective IM alternative to oral therapy.

May need to begin at lower doses as strong, prolonged (6 or more week) Herxheimer-like reactions have been observed.

Adults: 1.2 million U- three to four doses weekly.

Adolescents: 1.2 to 3.6 million U weekly.

May be used in pregnancy.
*******************************

Vancomycin- observed to be one of the best drugs in treating Lyme, but potential toxicity limits its use.
It is a perfect candidate for pulse therapy to minimize these concerns.

Use standard doses nd confirm levels.

Primaxin and Unisyn- similar in efficacy to cefotaxime, but often work when cephalosporins have failed.
Must be given q6 to q8 hours.

Cefuroxime- useful but not demonstrably better than ceftriaxone or cefotaxime.

*Ampicillin IV- more effective than penicillin G. Must be given q6 hours.


TREATMENT CATEGORIES

PROPHYLAXIS of high risk groups- education and preventive measures. Antibiotics are not given.


TICK BITES - Embedded Deer Tick With No Signs or Symptoms of Lyme (see appendix):

Decide to treat based on the type of tick, whether it came from an endemic area, how it was removed,
and length of attachment (anecdotally, as little as four hours of attachment can transmit pathogens).

The risk of transmission is greater if the tick is engorged, or of it was removed improperly allowing the tick's contents to spill into the bite wound.

High-risk bites are treated as follows (remember the possibility of co-infection!):
*********************************************

1) Adults: Oral therapy for 28 days.

2) Pregnancy: Amoxicillin 1000 mg q6h for 6 weeks. Test for Babesia, Bartonella and Ehrlichia.

Alternative: Cefuroxime axetil 1000 mg q12h for 6 weeks.

3) Young Children: Oral therapy for 28 days.
***************************************************

EARLY LOCALIZED - Single erythema migrans with no constitutional symptoms:

1) Adults: oral therapy- must continue until symptom and sign free for at least one month,
with a 6 week minimum.

2) Pregnancy: 1st and 2nd trimesters: I.V. X 30 days then oral X 6 weeks

3rd trimester: Oral therapy X 6+ weeks as above.

Any trimester- test for Babesia and Ehrlichia


3) Children: oral therapy for 6+ weeks.
*******************************************

DISSEMINATED DISEASE - Multiple lesions, constitutional symptoms, lymphadenopathy, or any other

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MANAGING LYME DISEASE, 16h edition, October, 2008
Page 20 of 37

manifestations of dissemination.

EARLY DISSEMINATED: Milder symptoms present for less than one year and not complicated by immune
deficiency or prior steroid treatment:

1) Adults: oral therapy until no active disease for 4 to 8 weeks (4-6 months typical)

2) Pregnancy: As in localized disease, but treat throughout pregnancy.

3) Children: Oral therapy with duration based upon clinical response.


PARENTERAL ALTERNATIVES for more ill patients and those unresponsive to or intolerant of oral
medications:

1) Adults and children: I.V. therapy until clearly improved, with a 6 week minimum.

Follow with oral therapy or IM benzathine penicillin until no active disease for 6-8 weeks.

I.V. may have to be resumed if oral or IM therapy fails.


2) Pregnancy: IV then oral therapy as above.


LATE DISSEMINATED: present greater than one year, more severely ill patients, and those with prior
significant steroid therapy or any other cause of impaired immunity:

1) Adults and pregnancy: extended I.V. therapy (14 or more weeks), then oral or IM, if effective, to same endpoint.

Combination therapy with at least two dissimilar antibiotics almost always needed.


2) Children: IV therapy for 6 or more weeks, then oral or IM follow up as above. Combination therapy usually needed.

[ 05-27-2009, 12:20 AM: Message edited by: bettyg ]

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billclo
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And he still does not even mention Tindamax, which has fewer side effects than Flagyl. [Frown] He's falling behind...
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bettyg
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bill, don't shoot the messenger... you could try contacting him yourself thru ILADS website to pass along your comments. [Smile]
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Marnie
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Vets know...

"A typical series of cancer risks now looks something like this:

1. A normal puppy or kitten receives one-too-many vaccinations and begins to decompensate
for the excess antigenic load with inflammation and allergic reactions.

The result of an excessive number or dose of vaccines is childhood allergies
(seen as eye, ear, nose, skin, and intestinal disorders).

With each annual vaccine
booster, the cycle of inflammation and allergic reactions repeats itself.

2. Inflammatory or allergic signs are suppressed with drugs such as antihistamines,
steroids and antibiotics.

Steroids suppress the immune response and are permissive
for cancer to get established.

Antibiotics destroy benign and beneficial bacteria,
allowing more virulent pathogens to survive, or opportunistic pathogens (such
as yeast) to occupy an open niche.

Without a deliberate effort to re-establish good
bacteria, the young animal is pushed further away from being normal.

3. Monotonous diets of dry pet food are the opposite of a cancer-preventive diet.

Largely formulated from grain by-products, animal proteins, animal fats and salt,
they lack nearly all the anti-cancer compounds commonly found in fresh foods
such as vegetables, fruits, nuts, oils and herbs.

Without a deliberate plan to offer a
cancer-preventive diet, these animals are at risk of developing cancer and other
chronic degenerative diseases, due to eating a poor diet.

4. Persistent pesticides used to prevent heartworm, flea and tick infections can tax
the body's ability to detoxify these chemicals.

There is a limit to our ability to
clear drugs, hormones, pesticides, toxic metals, synthetic preservatives and food
additives.

When we exceed the body's ability to remove these products, we increase
the likelihood of a mutagenic event.

5. When the limitations of modern health care (listed above) push the animal further
from self-regulation there is an increased need for nutrients to slow the aging
process and promote repair.

Unless a deliberate effort is made to fortify the diet
with protective antioxidants, essential fatty acids, and immune-supportive foods,
the innate immune system cannot keep up with the number of insults we have
placed on the body."

http://www.crvetcenter.com/images/Newsletters/crvc%20newsletter%20Sept05%20p2.pdf

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kreynolds
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bettyg,

Again thanks for putting this out there...

This has helped me with my son who is dealing with Lyme and Bart at the age of 3.

You are a tremendous help to all!! Thanks so much!

--------------------
Diagnosed CDC + 6/2007

Quest: + IGG Bands 18,23,39,41,58,66 and 93.

Quest: + IGM Bands
23,39

Quest: + Bartonella (B.Henselea & B. Quintana),+ Babesia, and + Mycoplasma and Lyme-Induced Addisons Disease

+ Biofilm blood test 12/2010

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bettyg
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thx marnie and roy for your comments...

up for parents with kids...

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Marnie
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The point is...we need to be knowledgeable and make INFORMED choices. Weigh the risks.

AND know how to prevent complications.

PROBIOTICS!!!

We must NOT forget to tell newbies how absolutely vital they are when taking abx!

Unlike doctors who never/rarely mention them when they write out abx scripts.

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MY3BOYS
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great post.,..thanks!!! i am trying to weigh info and educate myself about our kids. probable congenital transmission.

really dont want to dive straight into antibiotics with my 12 yr old. has ADHD and GI complaints already.,

already on probiotics and helps GI anyway. think natural may be better??? trying to learn thanks for the post

--------------------
i am not a Dr. any info is only for education, suggestion or to think/research. please do not mis-intuprest as diagnostic or prescriptive, only trying to help. **

dx in 08:lyme, rmsf, bart, babs, and m.pneumonia.

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bettyg
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my 3 boys, best wishes; no personal experience w/kids & lyme.

you could post here in medical asking for help from other parents..

subject: kids RX vs. natural; input needed by other parents; thx [Smile]

you could just copy your post from above to a NEW post in medical.

go to lower left hand corner and mark box so you get all replies; best wishes. [Smile] xox

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LindaS
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I'm new to the discussion...and to Lyme. Both my 12 yr. old son and I have had Lyme for 11 years, but have only recently been diagnosed. I stongly suspect my other two sons have it, but their symptoms are mild.

I've been on Doxicycline for 2 months and Flagyl for a few weeks. I've known about the importance of probiotics, however, learned the hard way that the diet cannot include carbohydrates or sugars while on antibiotics. My son hasn't been started on anitbiotics yet...we're using supplements and homeopathics to boost his immune system.

I am looking for help with a no carb/no sugar diet plan. I'm getting tired of the few things I've been eating and will need to feed the entire family this way soon. Any suggestions welcomed.

Linda

[ 07-01-2009, 01:16 PM: Message edited by: LindaS ]

--------------------
Linda

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Melodymaker
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Thanks Betty, this is just what I was looking for!!!

You Are WONDERFUL!!! [group hug]

--------------------
Wishing You Showers Of Blessings!
Lyme since Fall 1983 = Diagnosed Summer 2008
IV Rocephin 7 weeks Stopped due to drug fever
Now doxycycline
"For I know the plans I have for you...plans to give you hope and a future." Jeremiah 29:11

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bettyg
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rita, you are more than welcome!!

i couldn't read as is; so it helps me to break things up so they stand out to my 40 yr. neuro lyme mind [Smile]

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DanielleMC
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Does anyone know if your give birth to a chile while carrying Lyme disease, if it could be passed to your child?

--------------------
7/09- WB IGG Neg all bands -WB IGM Pos bands 23 & 41.
Treated w/ 21 days of Doxy.
10/09- WB IGG Pos bands 41 & 58 -WB IGM Pos bands 23 & 41.
04/11- WB IGG Pos band 66 -WB IGM Pos bands 23 & 41 Pos EBV.

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bettyg
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danielle, yes it can!

many moms here with CONGENITAL LYME KIDS.

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worrymama
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Says children should be given 28 days of Amoxicillan if Tick was erngorged. My one year old had an engorged tick tested positive for Lymes and was only given 21 days. Any advice would be appreciated. He finished about one week ago.
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