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Author Topic: IDSA journal - letters published in response to guidelines (4/15)
ldfighter
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Letters published in the IDSA's journal Clinical Infectious Diseases in response to the guidelines, and reply from Wormser et al.:

http://www.journals.uchicago.edu/CID/journal/contents/v44n8.html

(you can see the full text of letters in html or a single pdf file)

1133 Antibiotic Treatment of Children with Erythema Migrans
Maja Arnez

1134 Lyme Disease Guidelines--It's Time to Move Forward
Sam T. Donta

1135 Accuracy of Recommendations in the Infectious Diseases Society of America Clinical Practice Guidelines for Lyme Disease
Alan A. Pollock

1135 Concerns Regarding the Infectious Diseases Society of America Lyme Disease Clinical Practice Guidelines
Jim M. Wilson

1137 Reply to Pollock, Donta, Wilson, and Arnez
Gary P. Wormser, Raymond J. Dattwyler, Eugene D. Shapiro, John J. Halperin, Allen C. Steere, Mark S. Klempner, Peter J. Krause, Johan S. Bakken, Franc Strle, Gerold Stanek, Linda K. Bockenstedt, Durland Fish, J. Stephen Dumler, and Robert B. Nadelman

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Greatcod
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Thanks for putting this up. Lyme politics are hardball, no doubt about it.
Wormser's group has omnipotence down to a "science", just the way Steere did for the first 25 years--and of course he was wrong about almost everything.
It makes me crazy, seriously.

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hurtingramma
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I found it interesting that the only reply that had any "conflicts of interest" noted was the one from Wormser et al.

--------------------
"Few of us can do great things, but all of us can do small things with great love". Mother Theresa

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tanzi2u
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I didn't read the IDSA new "guidelines" in it's entirety, but by Wormser et al's response it sounds like they are denying that Bb is intracellular. Is this what they are going after next?
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David95928
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I couldn't open them.

--------------------
Dave

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ldfighter
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Access was temporarily restricted, but now it's available again.

???

Download the pdf now if you want it.

http://www.journals.uchicago.edu/cgi-bin/resolve?CID41377PDF

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timaca
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thanks for posting....Timaca
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Neil M Martin
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Here's the article w/ thanks due to U Chicago Edu
(and shorter paragraphs than the original).

Clinical Infectious Diseases 2007;44:1134-1135
2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4408-0023$15.00


--------------------------------------------------------------------------------
CORRESPONDENCE

Lyme Disease Guidelines--It's Time to Move Forward

Sam T. Donta

Falmouth Hospital, Falmouth, Massachusetts

Reprints or correspondence: Dr. Sam T. Donta, Falmouth Hospital, Ter Heun Dr., Falmouth, MA 02540 ([email protected]).


------------------------------

TO THE EDITOR--The recommendations in the Infectious Diseases Society of America's guidelines [1] regarding the chronic form of Lyme disease--referred to as posttreatment Lyme disease--seem to be encumbered by our inability to better define chronic Lyme disease itself.

We should not be debating the existence of persisting or relapsing symptoms. There is ample evidence for their existence [2-4]. Rather, we should be moving forward, discussing the nature of the chronic form of the illness and possible pathophysiologic mechanisms underlying it--that is, determining whether it is a persisting infection, whether autoimmunity is involved, and whether there are postinfectious sequelae.

The various types and combinations of symptoms do not resemble the typical aches and pains of daily living, but are unique in the vast majority of patients who experience them, regardless of whether they have received prior antibiotic treatment. The use of the term "post-Lyme" implies that infection is no longer present; however, it is not currently possible to determine whether infection persists.

Indeed, even in patients who have more obvious symptoms and signs of Lyme disease that persist beyond the initial erythema migrans phase and who have robust serologic responses to Lyme disease bacterial proteins, it is not currently possible to isolate the bacteria.

It would appear that patients with the chronic form of Lyme disease do not have the same robust serologic responses as patients with oligoarthritis [5-7], perhaps indicating inadequate host responses or bacterial factors that allow for the establishment of persisting infection.

Patients who have had known tick bites or Lyme disease-related rashes who subsequently developed chronic symptoms of Lyme disease were not included in the original studies of serologic responses of patients with Lyme disease [8]. In our experience, as well as in the experience of others, these patients have poorer and altered immunologic responses [5-7].

Our findings, which were based on careful observations of several thousand patients over the past 20 years, strongly support infection as the probable cause of chronic symptoms.

Antibiotic regimens consisting of tetracycline--not doxycycline [6] or the combination of a macrolide antibiotic and lysosomotropic agent [7]--appear to yield the best outcomes, including apparent cures or marked, stable improvements in >75% of patients; however, these treatments require that they be administered for a number of months to achieve good outcomes, depending on the duration of illness.

Our findings are also consistent with a persisting intracellular localization of the infection. The few controlled clinical trials that have been conducted thus far have employed different antibiotic regimens (i.e., intravenous ceftriaxone and doxycycline [9]) and treatments of shorter duration that have not been as effective as tetracycline or macrolide-lysosomotropic regimens.

It would be important to validate our observations with additional controlled trials, although measuring end points in patients who have chronic symptoms and few, if any, objective signs is fraught with limitations.

Until there are better, specific markers of disease activity, we should acknowledge that there are patients who are affected by Lyme disease to varying degrees that range from mildly symptomatic to severely debilitating and who depend on the expertise of the members of the Infectious Diseases Society of America for diagnosis and treatment.

In addition, we should move forward with plans to better understand the nature of this illness and to develop better ways to diagnose and treat the disease.

Acknowledgments

Potential conflicts of interest. S.T.D.: no conflicts

References
1. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43:1089-134. First citation in article | Full Text | PubMed

2. Asch ES, Bujak DI, Weiss M, et al. Lyme disease: an infectious and postinfectious syndrome. J Rheum 1994; 21:454-61. First citation in article | PubMed

3. Shadick NA, Phillips CB, Logigian EL, et al. The long-term clinical outcomes of Lyme disease. Ann Intern Med 1994; 121:560-7. First citation in article | PubMed

4. Donta ST. The existence of chronic Lyme disease. Curr Treat Options Infect Dis 2001; 3:261-2. First citation in article

5. Donta ST. Chronic and late Lyme disease. Med Clin N Am 2002; 86:341-9. First citation in article | PubMed | CrossRef

6. Donta ST. Tetracycline therapy of chronic Lyme disease. Clin Infect Dis 1997; 25:S52-6. First citation in article | PubMed

7. Donta ST. Macrolide therapy of chronic Lyme disease. Med Sci Monit 2003; 9:PI136-42. First citation in article | PubMed

8. Dressler F, Whalen JA, Reinhardt BN, Steere AC. Western blotting in the serodiagnosis of Lyme disease. J Infect Dis 1993; 167:392-400. First citation in article | PubMed

9. Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001; 345:85-92. First citation in article | PubMed | CrossRef

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Neil

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Tincup
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Well, I MUST do something I REALLY don't like to do. I MUST admit I was wrong.

I use to think the idiots were just plain old stupid.

Then.. year after year I watched and waited. It finally got SO bad, I thought to myself.. NO.. that's not it!

NO ONE can be THAT stupid!

Then I figured they must be doing this trash because they were just plain old EVIL!! They KNEW better! I KNOW they did!

But wrong again, I'm afraid. They aren't just plain old evil... NO!!!

The picture has changed again.. and it caught me off guard.

I NOW know they are BOTH- evil AND stupid! Or.. stupid and evil, which ever you prefer! Take your pick.. they keep flip flopping back and forth.

Like now...

How STUPID does a person have to be to think ANYONE is going to buy the evil garbage they are trying to sell?

What a nightmare they are!!!

Someone once told me they weren't fit to sleep with pigs. But I stuck up for the idiots! I said the person was incorrect. They ARE fit to sleep with pigs!

Of course that is ONLY my opinion!

And obviously SOMETIMES I am wrong!

[bonk]

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

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CaliforniaLyme
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Thank goodness for the Dr. Donta letter- wish there were more from LLMDs!*)!!!!!!!!!!!!!!!!

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There is no wealth but life.
-John Ruskin

All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer

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Robin123
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Tincup -- pigs are nice, intelligent animals -- they don't deserve such bedfellows, or hayfellows...
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troutscout
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They deserve to sleep in a bed of ticks, fleas and mosquitoes.

I just ran into no less than 4 people that have Lyme in Omaha over the weekend.

Luckily...the ones that DIDN"T know me took some literature. However, the person I have know n the longest and is VERY dear to my family...just won't listen...why? Denial....she said to me that she found that ALL of her symptons equalled Fibro...and that she wouldn't let anyone diagnose her with that. In the mean time....she's on the carousel.

Trout [Frown]

--------------------
Now is the time in your life to find the "tiger" within.
Let the claws be bared,
and Lyme BEWARE!!!
www.iowalymedisease.com
[/URL]  -

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david1097
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OK, lets see if they are willing to risk it. A simple question for this "panel of experts" AND the IDSA:

IS IT OK FOR PEOPLE WITH "POST LYME SYMTOMS" TO DONATE BLOOD.

If Yes,They should put it in writting.After that, everybody go and donate blood as soon as as often as you can.

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jimw
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Here are the other letters...

Concerns Regarding the Infectious Diseases Society of America Lyme Disease Clinical Practice Guidelines

Jim M. Wilson

Canadian Lyme Disease Foundation, Westbank, British Columbia, Canada

Reprints or correspondence: Mr. Jim Wilson, Canadian Lyme Disease Foundation, 2495 Reece Rd., Westbank, BC V4T 1N1, Canada ([email protected]).


--------------------------------------------------------------------------------

TO THE EDITOR--The Canadian Lyme Disease Foundation has several concerns with the Infectious Diseases Society of America's Lyme disease clinical practice guidelines [1]. I shall elaborate.

Throughout the guidelines, the erythema migrans rash is referred to 108 times and is claimed to be the predominant diagnostic feature of Lyme disease. Headaches, fatigue, cognitive dysfunction, neuropsychiatric issues, myalgias, tremors, tics, and parasthesias are given little or no attention, although they can be present in all stages of the illness; erythema migrans rash, on the other hand, normally is not, and has been overemphasized in the guidelines as being a predominant indicator of the disease [2]. As reported by Gill et al. [3] in 1995, only 18% of confirmed case patients reported experiencing a rash. The research studies cited in the guidelines [1] in support of percentages relative to rash incidence were not designed specifically to measure incidence of the erythema migrans rash; therefore, minimal value can be given to these data.

There is also concern over the recommendations regarding symptomatic chronic Lyme disease and late-stage Lyme disease. The following quote from the guidelines is evidence of poor scholarship: "There is no convincing biologic evidence for the existence of symptomatic chronic B. burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease" [1, p. 1094]. Strong evidence exists to the contrary, in both animal and human model studies, and has for years [4].

Late-stage Lyme disease is very poorly defined. Arthritic and neurologic manifestations have been mentioned, but are not well linked to the various symptoms that coexist with them. It is this array of variable symptoms, which often occur in the absence of arthritis or classic neurological manifestations, that collectively are so disabling in terms of quality of life for the patient and so costly for governments in terms of disability payments. The guidelines [1] refer to many of these symptoms as "the aches and pains of daily living" (p. 1115); however, no research has been presented that has had the specific design of determining all of the symptoms of late-stage Lyme disease. Symptoms such as overwhelming fatigue, pain, muscle dysfunction, cognitive dysfunction, psychiatric issues, breathing restrictions, eyesight and hearing problems, bowel dysfunction, and other manifestations that can be objectively measured, if proper measuring tools are employed, are common to late Lyme disease. Labeling these as "the aches and pains of daily living," or as a "post-Lyme disease syndrome" (p. 1116) is a travesty at worst and is premature at best. Many symptoms have been discounted; in the guidelines [1], entire classes of potential therapies are disregarded because of this poor recognition of symptoms.

Concerns also exist regarding seronegative Lyme disease. In Grignolo et al. [5], 50% of serum and CSF samples that had positive results with PCR were obtained from patients who had true-positive results at clinical examination but negative serologic testing results. Over 60% of Lyme disease-positive urine samples belonged to patients who had negative serologic analysis results [5]. In many other studies, seronegative Lyme disease has been proven [6].

In light of the above, as well as of the large global reserve of Lyme disease research, few conclusions can be drawn about late-stage Lyme disease until a definitive diagnostic test is found. The often-referenced "2-tiered testing" is not accurate enough to reliably identify Lyme disease [6, 7]. In addition, until a comprehensive series of postmortem studies of many conditions that have similar presentations (e.g., multiple sclerosis, Alzheimer disease, and chronic fatigue syndrome) is conducted to look for evidence of spirochetal infection, few conclusions can be drawn about what objective symptoms are to be attributed to late-stage Lyme disease.

The Infectious Diseases Society of America's guidelines [1] are far too exclusive and are thus inadequate to be a health care guide for physicians. The document represents a small cohort of authors who are largely supporting each others' work. The guidelines do not meet the stated objective of the guidelines document itself: "to provide clinicians and other health care practitioners with recommendations for treatment of patients in the United States with suspected or established Lyme disease, HGA (formerly known as human granulocytic ehrlichiosis), or babesiosis" (p. 1096). The Infectious Diseases Society of America's guidelines should be withdrawn and replaced with a document that has been written in collaboration with victims' groups and treating physicians.

Acknowledgments

Potential conflicts of interest. J.M.W.: no conflicts.

References
1. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43:1089-134. First citation in article | Full Text | PubMed
2. Stricker RB, Lautin A, Burrascano JJ. LD: The quest for magic bullets. Chemotherapy 2006; 52:53-9. First citation in article | PubMed | CrossRef
3. Gill R, Banerjee S, Banerjee M. LD cases acquired in British Columbia 1992-1994. Canadian Lyme Disease Foundation, 1995. Available at: http://canlyme.com/vanc1995.html. Accessed 6 March 2007. First citation in article
4. Relapse/persistence of Lyme disease despite antibiotic therapy. 16 September 2003. Available at: http://www.lymeinfo.net/medical/LDPersist.pdf. Accessed 6 March 2007. First citation in article
5. Grignolo MC, Buffrini L, Monteforte P, Rovetta G. 2001 Reliability of a polymerase chain reaction (PCR) technique in the diagnosis of Lyme borreliosis. Minerva Med 2001; 92:29-33. First citation in article | PubMed
6. Seronegativity in Lyme borreliosis and other spirochetal infections. 16 September 2003. Available at: http://www.lymeinfo.net/medical/LDSeronegativity.pdf. Accessed 6 March 2007. First citation in article
7. Coulter P, Lema C, Flayhart D, et al. Two-year evaluation of Borrelia burgdorferi culture and supplemental tests for definitive diagnosis of Lyme disease. J Clin Microbiol 2005; 43:5080-4. First citation in article | PubMed | CrossRef


Accuracy of Recommendations in the Infectious Diseases Society of America Clinical Practice Guidelines for Lyme Disease

Alan A. Pollock

New York University School of Medicine, New York


Reprints or correspondence: Dr. Alan A. Pollock, 184 E. 70th St., New York, NY 10021 ([email protected]).


--------------------------------------------------------------------------------

TO THE EDITOR--I read with interest the recently revised Infectious Diseases Society of America guidelines for the diagnosis and management of Lyme disease [1]. Several significant inaccuracies were noted.

The statement was made that "there is no convincing biologic evidence for the existence of symptomatic chronic B. burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease" [1, p. 1094]. This is clearly contradicted in a report by Phillips et al. [2], in which Borrelia burgdorferi bacteremia was confirmed using fluorescent antibody immunoelectron microscopy in 91% of 47 symptomatic patients who had experienced relapse after receiving oral and intravenous antibiotic therapy. This research was, in fact, cited by Klempner et al. [3] in the "Laboratory Studies" section of their report; however, the actual point of the article seems to have been missed--namely, that organisms may persist despite "standard therapy." Persistent or relapsing symptoms may, therefore, be due to active infection rather than to slow resolution of inflammation, and this may be the basis for some of the panel's observations that a second course of treatment may be needed for some patients.

Second, the guidelines state that "there is no convincing evidence in North America for the persistence of B. burgdorferi in the skin of humans after treatment with antibiotic regimens known to be active against B. burgdorferi in vitro" [1, p. 1117]. Although reported from Europe, the findings of Hunfeld et al. [4], in which repeat skin biopsy cultures were still positive after treatment, suggest that the same phenomena could be observed in North America, particularly because the in vitro sensitivities that they observed did not indicate resistance on the basis of increasing MICs.

Third, the statement is made that, "because of a lack of biologic plausibility, lack of efficacy, [and] absence of supporting data ... the following are not recommended for treatment of patients with any manifestation of Lyme disease: ... benzathine penicillin G, ... and others" [1; p. 1094]. This is contradicted by Dr. Steere's own data [5, 6], in which benzathine penicillin G was used successfully in the treatment of established arthritis. Although the success rate appeared to be modest (35%), therapy with benzathine penicillin was clearly more effective than placebo, which was associated with no improvement (P ( .02). Therefore, some patients may respond to this treatment. Whether this therapy can be applied to other extra-articular manifestations of Lyme disease should be studied.

Fourth, the specific recommendations regarding the use of oral doxycycline omitted the important issue of reduced bioavailability when the drug is coadministered with free calcium. This could explain the apparent "failure" of tetracycline treatment in some patients who were not advised to restrict calcium intake for several hours before and after the drug's administration.

Acknowledgments

Potential conflicts of interest. A.A.P: no conflicts.

References
1. Wormser G, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43:1089-134. First citation in article | Full Text | PubMed
2. Phillips SE, Mattman LH, Hulinska D, et al. A proposal for the reliable culture of Borrelia burgdorferi from patients with chronic Lyme disease, even from those previously aggressively treated. Infection 1998; 26:364-7. First citation in article | PubMed
3. Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001; 354:85-92. First citation in article | PubMed | CrossRef
4. Hunfled KP, Ruzic-Sabljic E, Norrid D, et al. In vitro susceptibility testing of Borrelia burgdorferi sensu lato isolates cultures from patients with erythema migrans before and after antimicrobial chemotherapy. Antimicrob Agents Chemother 2005; 49:1294-301. First citation in article | PubMed | CrossRef
5. Steere AC, Green J, Hutchinson GJ, et al. Treatment of Lyme disease. Zentralbl Bakteriol Mikrobiol Hyg [A] 1987; 263:352-6. First citation in article | PubMed
6. Steere AC, Green J, Schoen RT, et al. Successful parenteral penicillin therapy of established Lyme arthritis. N Engl J Med 1985; 312:869-74. First citation in article | PubMed

Antibiotic Treatment of Children with Erythema Migrans

Maja Arne

Department of Infectious Diseases, University Medical Centre Ljubljana, Slovenia


Reprints or correspondence: Dr. Maja Arne, Dept. of Infectious Diseases, Medical Centre Ljubljana, Japljeva 2, 1525 Ljubljana, Slovenia ([email protected]).


--------------------------------------------------------------------------------

TO THE EDITOR--A recently published article [1] claims to present evidence-based guidelines for the management of patients with tick-transmitted diseases--primarily in the United States, but also in Europe, because traveling between the 2 continents is common. It also states that the recommendations were based, whenever possible, on studies conducted in the United States that took into consideration differences in the species of Borrelia that cause Lyme disease in the United States and in Eurasia.

Because no prospective, controlled, randomized clinical studies of the treatment of Lyme disease in children have been performed in the United States, we believe that prospective, randomized clinical studies originating in Europe should have been considered--even more so because the 2 European members of the panel were, beyond any doubt, familiar with them. These studies present level A-I evidence about the subject and generate data-supporting therapy that is cheaper, has fewer adverse effects, and is ecologically more friendly. I would like to focus your attention on them.

At our department, from 1996 to 2003, we conducted 3 prospective, randomized clinical studies of the antibiotic treatment of children less than 15 years of age who had solitary erythema migrans [2-4]. Patients were followed-up for at least 1 year after inclusion in the study. We evaluated the efficacy of treatment (duration of erythema migrans and duration of associated local and/or systemic symptoms after institution of therapy), development of minor and/or major manifestations of Lyme borreliosis, drug-related adverse effects of treatment, and the appearance of Jarish-Herxheimer's reaction. Forty-six patients were treated with cefuroxime axetil, 86 received phenoxymethylpenicillin, 126 received azithromycin, and 84 received amoxicillin. The results of our studies showed comparable efficacy of the treatment and comparable appearance of minor and major manifestations of Lyme borreliosis, regardless of antibiotic used. Adverse effects of treatment and the appearance of Jarish-Herxheimer's reaction were more frequently detected in children who were treated with cefuroxime axetil than in those who received amoxicillin, azithromycin, or phenoxymethylpenicillin.

In Slovenian children less than 15 years of age who have multiple erythema migrans, we strongly suggest intravenous therapy with ceftriaxone for all patients, not only for those who have symptoms and signs of specific neurological involvement, because 18%-26% of our patients with multiple erythema migrans have associated meningitis without obvious clinical signs and/or symptoms of CNS involvement [5, 6]. Even in patients with normal CSF results, Borrelia burgdorferi sensu lato is isolated from blood and/or CSF samples [5-7]. When treating children with antibiotics, attention should be paid to the following properties of the drug: efficacy, adverse effects, type of delivery, administration, duration of treatment, taste, price, and influence on bacterial resistance.

Because of these reasons, the evidence-based recommendations (A-I) for the treatment of children in Slovenia with solitary erythema migrans who are less than 15 years of age are as follows:

1. Oral phenoxymethylpenicillin, 100,000 IU per kg per day (maximum, 3 million IU per day), divided into 3 equal doses, administered every 8 h for 14 days.

2. Oral azithromycin, 20 mg per kg per day (maximum, 1000 mg per day) for the first day, followed by 10 mg per kg per day (maximum, 500 mg per day) in 1 daily dose for 4 additional days.

3. Oral amoxicillin, 50 mg per kg per day (maximum, 1500 mg per day), divided into 3 equal doses, for 14 days.

4. Oral cefuroxime axetil, 30 mg per kg per day (maximum, 1000 mg per day), divided in 2 equal doses, administered every 12 h for 14 days.


We do not belive that patients who are treated with azithromycin should be more closely monitored than patients who are treated with other recommended antibiotics. In Slovenia, doxycycline is used only in children who have solitary erythema migrans with concomitant tick-transmitted pathogenic infection that is susceptible only to doxycycline or in patients, regardless of age, who have neuroborreliosis and who are allergic to -lactams and/or penicillin. In children with multiple erythema migrans, we recommend intravenous ceftriaxone (70-100 mg per kg per day; maximum, 2 g per day) in 1 daily dose for 14 days.

We believe that our data and recommendations for treatment of children less than 15 years of age who have solitary erythema migrans should be included in the recently published guidelines, because they provide valuable information with direct implications regarding therapy. Without the data presented in our study, your recommendations are not up-to-date. It is our strong opinion that it is inappropriate and not scientifically justified to use studies that have been performed involving adults to provide the basis of recommendations for therapy in children when data from A-I-level studies involving children are available.

Acknowledgments

Potential conflicts of interest. M.A.: no conflicts.

References
1. Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006; 43:1089-134. First citation in article | Full Text | PubMed
2. Arne M, Radel-Medveek A, Pleterski-Rigler D, Rui-Sablji E, Strle F. Comparison of cefuroxime axetil and phenoxymethylpenicillin for treatment of children with solitary erythema migrans. Wien Klin Wochenschr 1999; 111:911-5. First citation in article | PubMed
3. Arne M, Pleterski-Rigler D, Lunik-Bufon T, Rui-Sablji E, Strle F. Solitary erythema migrans in children: comparison of treatment with azithromycin and phenoxymethylpenicillin. Wien Klin Wochenschr 2002; 114:498-504. First citation in article | PubMed
4. Arne M, Pleterski-Rigler D, Lunik-Bufon T, Rui-Sablji E, Strle F. Comparison of azithromycin and amoxicillin for treatment of children with solitary erythema migrans. In: Program and abstracts of the 10th International Conference on Lyme borreliosis and other tick-borne diseases, 11-15 September 2005 (Vienna). Vienna: Medical University of Vienna, 2005:113. First citation in article
5. Arne M, Pleterski-Rigler D, Ahcan J, Rui-Sablji E, Strle F. Demographic features, clinical characteristics and laboratory findings in children with multiple erythema migrans in Slovenia. Wien Klin Wochenschr 2001; 113:98-101. First citation in article | PubMed
6. Arne M, Pleterski-Rigler D, Lunik-Bufon T, Rui-Sablji E, Strle F. Children with multiple erythema migrans: are there any pre-treatment symptoms and/or signs suggestive for central nervous system involvement? Wien Klin Wochenschr 2002; 114:524-9. First citation in article | PubMed
7. Arne M, Pleterski-Rigler D, Rui-Sablji E, Strle F. Simultaneous isolation of Borrelia burgdorferi sensu lato from blood and cerebrospinal fluid in three patients with multiple erythema migrans. J Pediatr Infect Dis 2006; 1:123-5. First citation in article

Posts: 144 | From British Columbia | Registered: Sep 2002  |  IP: Logged | Report this post to a Moderator
Lymetoo
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quote:
Originally posted by troutscout:
They deserve to sleep in a bed of ticks, fleas and mosquitoes.

YUP!

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

Posts: 94751 | From Texas | Registered: Feb 2001  |  IP: Logged | Report this post to a Moderator
Lymetoo
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quote:
Originally posted by david1097:
OK, lets see if they are willing to risk it. A simple question for this "panel of experts" AND the IDSA:

IS IT OK FOR PEOPLE WITH "POST LYME SYMTOMS" TO DONATE BLOOD.

If Yes,They should put it in writting.

I would like to see that in writing too!

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

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CaliforniaLyme
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Wonderful letter Jim*)!*)!)!! Thank you!!!!

--------------------
There is no wealth but life.
-John Ruskin

All truth goes through 3 stages: first it is ridiculed: then it is violently opposed: finally it is accepted as self evident. - Schopenhauer

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Greatcod
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Wormser's own hospital will not accept blood from Post Lyme folks...donors need to be symptom free for 6 months.
But it appears that the cause is caution on the part of the Red Cross, and not an outright endorsement of the continuing infection view.

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