What I am looking for are published studies that show that long term ABX, either IV or oral, are of value in treating Lyme... I know that Dr D has published on this, and that Dr F has also. Do you know of any others. I understand that there is an enormous amount of ancetidotal evidence is available, and I I don't question it veracity, but I am interested in published evidence.
Posted by Aniek (Member # 5374) on :
Sorry, but it doesn't exist. None of the research looks at more than 3 months. Dr. F's study did find that some symptoms (I think pain) were reduced, but the neurological symptoms came back after treatment stopped.
The only other study that looked at 3 months is not friendly.
Posted by lou (Member # 81) on :
There are some animal studies that suggest this.
And there are a lot of human patients who have improved on longterm abx, but apparently thousands of such cases do not constitute scientific proof. Instead, a small study like Klempner's which wasn't really longterm, is said to prove the opposite. It is a mad world.
Posted by adamm (Member # 11910) on :
Our experience is the only proof.
Posted by shazdancer (Member # 1436) on :
Peer-reviewed, published studies of long-term treatment are hard to come by. They include the Klempner study, the Krupp study, and the Fallon study.
Another possible resource is non-published studies. Some have value added by being selected for presentation at medical conventions in front of their peers, or by being selected for continuing education accreditation.
http://www.medscape.com/viewarticle/412991 from the 13th International Conference on Lyme Disease, 2000, and used for CME credits. Oksi from Finland describes longer treatment and treatment for relapse in neuroborreliosis.
Steere et al., "Therapy for Lyme Arthritis," Arthritis Rheum 2006
Full text of Steere study is at http://www3.interscience.wiley.com/cgi-bin/fulltext/113383826/HTMLSTART [The following quote refers to patients who had already received abx treatment.] "During recurrent episodes, 2 patients who had received NSAIDs in the post-antibiotic period had negative PCR results for B burgdorferi DNA in joint fluid but were re-treated with oral doxycycline for 30 days, with resolution occurring within several weeks. The third patient, who had received hydroxychloroquine in the post-antibiotic period, was the only patient who had recurrent arthritis and a positive PCR result. She had 2 recurrences of arthritis, each of which was treated with IV antibiotics for 1 month."
Posted by Vermont_Lymie (Member # 9780) on :
From an earlier post -- long term use of mino in neurosyphilis, another spirochetal diease:
Clinical Infectious Diseases 2000;31:846
(Yes, this was published by the IDSA! Don't they read their own literature??)
Possibility of the Use of Oral Long-Acting Tetracyclines in the Treatment of Lyme Neuroborreliosis
SIR--We have read with interest and would like to praise both the well-done study of Dotevall and Hagberg [1] and the ensuing discussion regarding the use of doxycycline versus minocycline for treatment of CNS spirochetal infections [2, 3].
We believe that an additional comment on this discussion may be warranted.
We previously performed an open study on the treatment of neurosyphilis in patients who were allergic to penicillin, using oral minocycline, 100 mg b.i.d. for 14 consecutive days per month for 9 months [4].
We were surprised that no clinically detectable CNS or gastrointestinal side effects were registered over a total of 294 person-days of administration of minocycline, although they were actively sought by means of a follow-up questionnaire and clinical examination.
Our selection of a long-acting tetracycline for treatment of our patients Was made on the basis of tetracycline activity against Treponema pallidum, the satisfactory pharmacokinetics of doxycycline across the blood-brain barrier [5], and the excellent lipid solubility of minocycline [6].
However, we chose minocycline because it was the only tetracycline available in our hospital pharmacy.
Therefore, our experience supports the use of oral minocycline for CNS infections by spirochetes, including not only Borrelia burgdorferi, as suggested by Cunha [2], but also T. pallidum.
In this regard, some of the disadvantages of the use of minocycline--namely, discoloration of the teeth, skin, and nails--are likely to be either irrelevant or not applicable to the majority of patients, because tertiary CNS manifestations of T. pallidum and infection most frequently appear in adults and not in teens and children.
In general, this also applies to most patients with neuroborreliosis. A recent epidemiological study of Lyme disease in Europe [7] showed that the incidence of neuroborreliosis in children aged <15 years [28%] was higher than that in adults [14%].
However, given the higher incidence of Lyme disease among adults [>75%], a semisynthetic tetracycline could have been administered to >70% of the patients with neuroborreliosis.
However, we believe that the real point at issue in the previous discussion [2, 3] is represented by the possibility of safe and effective use of oral long-acting tetracyclines for tertiary manifestations of spirochetal diseases.
This point is not clearly indicated in widely distributed guides for the treatment of infectious diseases [8, 9], in particular with respect to neurosyphilis and the loading dose of doxycycline for neuroborreliosis.
On the basis of clinical experience, it would seem that both doxycycline and minocycline can be used for these conditions.
Until a controlled trial is performed (with, possibly, control of plasma, CSF, and tissue pharmacokinetic parameters) in patients with neurosyphilis or neuroborreliosis, only personal experience and preferences, in addition to adequate clinical monitoring, should be used to instruct the choice of drug.
Andrea De Maria1 and Alberto Primavera2 Departments of 1Internal Medicine and 2Neurology, University of Genova, Genova, Italy
References
1. Dotevall L, Hagberg L. Successful oral doxycycline treatment of Lyme disease- associated facial palsy and meningitis. Clin Infect Dis 1999;28:569-74
2. Cunha BA. Minocycline versus doxycycline in the treatment of Lyme neuroborreliosis. Clin Infect Dis 2000; 30:237-8.
3. Dotevall L, Hagberg L. Adverse effects of minocycline versus doxycycline in the treatment of Lyme neuroborreliosis. Clin Infect Dis 2000; 30:410-1.
4. De Maria A, Solaro C, Abbruzzese M, Primavera A. Minocycline for symptomatic neurosyphilis in patients allergic to penicillin. N Engl J Med 1997;337:1322-3.
5. Yim CW, Flynn NM, Fitzgerald FT. Penetration of oral doxycycline into the cerebrospinal fluid of patients with latent or neurosyphilis. Antimicrob Agents Chemother 1985; 28:347-8.
6. Kapusnik-Uner JE, Sande MA, Chambers HF. Tetracyclines, chloramphenicol, erythromycin and miscellaneous antibacterial agents. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, Goodman Gilman A, eds. The pharmacological basis of therapeutics. Vol 1. New York: McGraw- Hill,1996:1123-53.
7. Berglund J, Eitrem R, Ornstein K, et al. An epidemiologic study of Lyme disease in southern Sweden. N Engl J Med 1995;333:1319-24.
8. Bartlett JG. Pocket book of infectious disease therapy. Baltimore: Williams and Wilkins, 1998:309-14.
9. Gilbert DN, Moellering RC, Sande MA. Clinical approach to initial choice of antimicrobial therapy. In: Gilbert DN, Moellering RC, Sande MA, eds, The Sanford guide to antimicrobial therapy. Hyde Park, VT: Antimicrobial Therapy, 1999:1-16.
Reprints or correspondence: Dr. Andrea De Maria, Department of Internal Medicine, Padiglione Maragliano, University of Genova, #10 Largo Rosanna Benzi, Genova, 16132 Italy, [email protected]