Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Question- It is ok for pharmacists to GUESS at what would work in lieu of Doxycycline for Lyme disease (and publish these opinions)?
Seems like someone (insurer?) wants a cheaper antibiotic to be used for Lyme, BEFORE the new IDSA guidelines are released. More “fluff” for the guidelines?
From the full article- “Doxycycline, a tetracycline antibiotic with myriad labeled indications, experienced a 2000% increase in average retail price between 2012 and 2013 [6], and currently the list price for doxycycline is as high as $19 per capsule in our network.” ...
"Close to 150 antibacterial agents experienced shortages between 2001 and 2013, with nearly one quarter of these drugs experiencing more than 1 shortage [2].
The impact of a drug shortage is felt at the patient-physician interface and on the institutional level. Seventy-eight percent of infectious diseases physicians surveyed reported that antimicrobial shortages have had a negative impact on their practice [5].
Furthermore, the difficulty of drug procurement during a shortage is often compounded by a substantial price increase for the products that remain on the market.
Members of the US Congress have deliberated over how to assure the availability of clinically important generic drugs in the setting of shortage-driven market manipulations [4]. A centerpiece of congressional discussions was the example of oral doxycycline….”
"The most recent guideline from the IDSA includes an option for prophylaxis with single-dose doxycycline in patients meeting strict criteria [76]. Therefore, when prophylaxis is indicated in the absence of doxycycline, we recommend clinicians consider minocycline and exercise shared decision making [77].
We recommend that this conversation include at least 5 key points:
(1) the overall risk of developing Lyme disease is low and forgoing prophylaxis may be reasonable;
(2) there are effective treatments for early Lyme disease;
(3) the benefit of antibiotic prophylaxis is small and may be offset by the risk for adverse effects with antibiotic treatment;
(4) doxycycline is usually recommended, however, if unavailable, minocycline is a similar but less studied antibiotic; and
(5) although minocycline may work better, as well, or not as well other antibiotics, it is suggested as a potential alternative because it works similarly to doxycycline, and it has been shown to be effective in patients who have developed Lyme disease."
To no one in particular: Why is there a protracted doxy shortage to begin with? This has been a problem for a couple of years - why has it not been remedied yet?
We have all heard of abx stewardship. Does this door swing one way only?
Moreover, parts of the US have documented Bb-infected tick rates approaching 50%. Much of the NE, for example. Why then would anyone recommend a treatment policy that forgoes prophylaxis?
Edited to add: The authors cite doxy efficacy at eradicating EMs within a month. Bets on what % of that treatment group would have had their EM resolve without treatment? The bull's eye rash is not the target...
Posts: 228 | From Unitied States | Registered: Jul 2015
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- Mino can be harder to tolerate for some due to the vestibular effects and (seems to me) it being more ototoxic than doxy, extra steps may be needed to help the liver / ears.
Topic: TINNITUS: Ringing Between The Ears; Vestibular, Balance, Hearing with compiled links - including HYPERACUSIS -
Posts: 48021 | From Tree House | Registered: Jul 2007
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Hey duncan- you made me laugh! Bingo! The "cure" for Lyme was once determined to be if the rash disappeared. And it disappears on its own most of the time anyhow, with or without intervention. And believe it or not, studies were based on this theory (and obviously still are)! It is just more IDSA/CDC garbage.
Glad you noticed that and mentioned it.
As for why doxy costs went to high- I've heard a number of reports and all have a bit of an IDSA/CDC stink on them, so can't say what is true. It may be that they charge what they do because they can.
I once asked an Amtrak employee why the cost of a ticket on the auto train was so much higher today than if you booked it in advance a coupe months before the trip. She said they can charge that higher price at any time because they are the only ones offering the service- in other words, they do it because they can.
Here is more info on the costs per pill and even by country.
Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
Yes, Keebler. Two totally different meds. I can't do mino, tried and tried, but no more. I don't think this study should have been published for many reasons, yours being a very important one!
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