I ask you this question for another member of our Dutch Lyme-sites.

The story is about a 4 years old girl who got bitten by a tick about two weeks ago. First the mother was send away to wait what will happen. Butafter a few days the girl got sick (from a healthy playing and running child to a girl that wants to watch t.v. all the time - she can sit - and just falls asleep on the middle of the day on the couch). And got an EM near the bite.

They went back to the doctor who discribed 3 times a day 3 ml Amoxicilline for 2 weeks. Later the mother got this doctor so far that he described 3x 5ml for four more weeks (6 weeks together).

That was about 10 days ago. The girl has still this fatigue and isn't herself. I told the mother that this could be the Amoxi itself or a Herx.

Now my questions to you are:
- Can this be a Herx (in the first stage of LD)?
- Is this the good protocol for a 4-years old in the first stage of LD (the child weights 15 kg; so they count 15 x 50 mg = 750 mg = 5 ml)?
- How is the research about this case in other words can I give this mother some articles to make her believe that her child can be cured after this abx treatment?

Thanks in name of an anxious mother,

This is very nice of you to help this mom and her child.

I can tell you that Doctor Jones here (the Lyme pediatrician) automatically puts any chils on thirty days Amox for a known tick attatchment with NO symptoms. Just for the bite.

He then has parents watch for signs of things like fever, poor muscle tone, fatigue, irritability..stomach distress..dark circles..joint pain..all the LD symptoms. They are to call back and have an exam if they develop these symptoms.

If the child has the rash and symptoms develop before starting the abx, he will treat longer. With instructions on what to watch for.

I guess it is (maybe??) possible that the six weeks could be enough for this little one, but I think the condition needs to be tracked carefully. Did she start the higher dose right away? Or did they start low and then go up?

Although I think it could well be a Herx now on the Amox, as the child had symptoms to begin with (and a rash) ..indicating that the disease was disseminated (had spread). If it is a Herx, Doctor Jones would probably treat longer.

Doctor Burrascano's Guidelines have a rough outline of dosages..is the dose given the same as what he reccommends for a child with early disseminated Lyme (with rash and fatigue?)

I'll try and pull that up here..but I have to give my son meds here in a minute so I will try and come back.

The thing I would urge to be the best thing to do is for Mom, or the Doctor (if he is willing) to call Doctor Jones.

US 203-772-1123 Ask for Lisa or Tanya

His office staff can advise whether the dose and length of treatment are right based on exactly what has happened and the child's weight..and symptoms.

The Doctor and/or Mom could then watch the child, and could call again with what develops. The office can tell them what to watch for as well.

The Mom should have a list and some articles on what to watch out for now and in the future.

Doctor Burrascano's Guidelines at www.ilads.org she should print and have by her side.

I can also try and get back to help find more than that..

Or maybe others here can give the links to Doctor Jones writing, and the LDA pamphlet called "the ABC's of Lyme Disease" would be excellent for her to have as well.

That's here on the LDA site I think.

Back later..

Mo

Special Issues for Children: "Current research indicates that the Lyme disease bacteria, Borrelia burgdorferi, can be transmitted within hours of an infected tick attachment. Failure of parents and teachers to recognize Lyme disease early in its course can result in a child developing a chronic difficult to treat infection in the brain, eyes, joints, heart and elsewhere in the body. In my experience treating 5,000+ children birth to 18 with Lyme disease, 50% have no tick attachment history, 10% or less have an erythema migrans (bullseye rash) history, but all have a history of living in or having visited a Lyme endemic area and have a decline in the way they play and perform in school. They are tired, wilt easily, have dark circles under their eyes and are sick." Dr. Jones in LDA's ABC's of Lyme Disease.

ABC's of Lyme Disease:
http://www.lymeinfo.net/lymefiles.html#brochures

Doctor B:
http://www.ilads.org/burrascano_1102.htm

In his paper, under treatment guideline:

TREATMENT CATEGORIES

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 and percent infected, how it was removed, and length of attachment (nymphs: at least one day; adults: anecdotally, as little as four hours). 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 coinfection!):

Adults: Oral therapy for 21 days.
Pregnancy: Amoxicillin 1000 mg q6h for 6 weeks. Test for Babesia, Bartonella and Ehrlichia.
Alternative: Cefuroxime axetil 1000 mg q12h for 6 weeks.
Young Children: Oral therapy for 21 days.
((((((***(DOC J DOES THIRTY)))))

EARLY LOCALIZED -- Single erythema migrans with (((**NO**))) constitutional symptoms:

Adults: oral therapy for 6 weeks.
Pregnancy: 1st and 2nd trimesters: IV X 21 days then oral X 6 weeks
3rd trimester: Oral therapy X 6 weeks.
Any trimester -- test for Babesia, Bartonella, and Ehrlichia
**Children: oral therapy for 6 weeks.

DISSEMINATED DISEASE -- Multiple lesions, constitutional symptoms, lymphadenopathy, or any other manifestations of dissemination.

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

Adults: Oral therapy until no active disease for 4 weeks (4-6 months typical)
Pregnancy: As in localized disease, but duration as above. Treat throughout pregnancy, and do not breast feed.
((((****Children: Oral therapy with duration based upon clinical response.))))

I think she should call Doc J's ofice for the dosage. What is her weight?

Mo

Thanks for your reply.

The girl is 15 kg and the later dose (3x5ml) is based on the new ILADS guideline (summary). But I shall ask how long she was on the lower dose (3ml) before she got this dose.

I will put a link to this topic on our Dutch forum so the parents can read your reply aswell and see what they will do. Their doctor sounds not so helpfull and interested so I don't think he will call dr. Jones, but you never know.

Thanks and Greetings from Holland,

Ingeborg

For as far as I know this little girl is healthy again. She had diarree one day during her 6 weeks on abx, but for the rest it seems to help her a lot. But now, when this 6 weeks are allmost over, her parents want to know how big is the chance that she will have a relapse?

I know thaat you ain't MD's yourself, but maybe you'll be able to give them some answer?

Thanks and greetings from the Netherlands,

Ingeborg and Nic.