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New Evidence on Lyme Disease Supports Need for Extended Treatment Therapy Evidence-based article in prestigious infectious disease journal supports ILADS treatment recommendations.
Bethesda, MD (PRWEB) June 15, 2007 -- The International Lyme and Associated Diseases Society (ILADS) today announced that, for the first time, evidence supporting the ILADS position on the treatment of Lyme disease has been published in the journal Clinical Infectious Diseases (CID), considered one of the most prestigious publications in the field of infectious diseases and microbiology. It is the first time that evidence supporting the ILADS position has ever been published in an American infectious disease journal.
The duration of treatment for Lyme disease has been a contentious issue among physicians. The fact that two major medical associations - the Infectious Diseases Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS) - have released conflicting guidelines for the diagnosis and treatment of Lyme disease has fueled the controversy.
"Publication of our recommendations about the most effective treatment for Lyme disease in a journal like CID is a milestone for ILADS," said Dr. Raphael Stricker, president of ILADS. "Doctors, patients and insurance companies need to know that the IDSA guidelines are flawed."
Difficult to Diagnose A primary factor in the Lyme disease controversy is that the disease can be difficult to diagnose. Not every patient suffers from the typical "bull's-eye" rash and joint inflammation, considered classic symptoms of Lyme disease that is transmitted by the bite of a tiny tick. ILADS research indicates that only 50%-60% of patients typically recall a tick bite; the rash is reported in only 35% to 60% of patients; and joint swelling typically occurs in only 20% to 30% of patients. And given the prevalence of over-the-counter anti-inflammatory medication such as Ibuprofen, the joint inflammation is often masked.
Many patients with Lyme disease will continue to experience a variety of symptoms, even after the treatment recommended by IDSA. Some of these patients go on to develop multiple nonspecific symptoms, making it very difficult to diagnose chronic Lyme disease.
One reason for this difficulty is that Borrelia burgdorferi, the corkscrew-shaped bacteria that causes the disease, has an unusual genetic makeup. This allows the bacteria to screw its way into a variety of cells and evade the body's immune system. According to ILADS research, the Lyme bacteria invades multiple tissues and is able to assume a dormant state much like tuberculosis. This can make treatment much more difficult.
Extended Therapy Based on extensive clinical evidence, ILADS maintains that extended antibiotic therapy for Lyme disease is sometimes necessary, particularly in later disease that is more difficult to eradicate. Studies have shown that Borrelia burgdorferi can persist after antibiotic treatment. In particular, studies conducted in animals - including mice, dogs and monkeys - indicate that the corkscrew-shaped bacteria can persist after treatment is completed. Persistence in humans has been confirmed by culture or molecular testing in at least a dozen studies.
"Science in this area is still evolving," according to Stricker. "We don't have all the answers and it is too early to adopt treatment strategies that assume we do. Meanwhile, doctors need flexible treatment approaches," he said.
The article describing the ILADS position on treatment of Lyme disease will be published in the July 15 issue of Clinical Infectious Diseases.
About ILADS ILADS is a nonprofit, international, multidisciplinary medical society dedicated to the diagnosis and appropriate treatment of Lyme disease and associated tick-borne infections. ILADS promotes understanding of tick-borne diseases through research and education and strongly supports physicians and other health care professionals dedicated to advancing the standard of care for tick-borne diseases.
For more information contact Pam Kahl at 503.284.1534.
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It looks like Dr. S's article is part of a point / counterpoint. If anyone has FULL access to the articles I would like to have them in PDF for my files.
Point: Antibiotic Therapy Is Not the Answer for Patients with Persisting Symptoms Attributable to Lyme Disease
Abstract It is not well understood why some patients develop a subjective syndrome that includes considerable fatigue, musculoskeletal aches, and neurocognitive dysfunction after receiving standard antibiotic courses for the treatment of Lyme disease. Some practitioners use the term "chronic Lyme disease" and order prolonged courses of oral and parenteral antibiotics, believing that persistent infection with Borrelia burgdorferi is responsible.
However, well-performed prospective studies have found neither evidence of chronic infection nor a benefit worthy of long-term antibiotic therapy for these patients. Such extended antibiotic therapy poses hazards and cannot be viewed as acceptable. The term "chronic Lyme disease" should be discarded as misleading; rather, the term "postLyme disease syndrome" better reflects the postinfectious nature of this condition.
Further research is necessary to understand possible mechanisms of these chronic symptoms following Lyme disease as well as to find effective therapies.
International Lyme and Associated Diseases Society, Bethesda, Maryland
(See the point by Auwaerter on pages 143-8)
Background. Controversy exists regarding the diagnosis and treatment of Lyme disease. Patients with persistent symptoms after standard (2-4-week) antibiotic therapy for this tickborne illness have been denied further antibiotic treatment as a result of the perception that long-term infection with the Lyme spirochete, Borrelia burgdorferi, and associated tickborne pathogens is rare or nonexistent.
Methods. I review the pathophysiology of B. burgdorferi infection and the peer-reviewed literature on diagnostic Lyme disease testing, standard treatment results, and coinfection with tickborne agents, such as Babesia, Anaplasma, Ehrlichia, and Bartonella species. I also examine uncontrolled and controlled trials of prolonged antibiotic therapy in patients with persistent symptoms of Lyme disease.
Results. The complex "stealth" pathology of B. burgdorferi allows the spirochete to invade diverse tissues, elude the immune response, and establish long-term infection. Commercial testing for Lyme disease is highly specific but relatively insensitive, especially during the later stages of disease. Numerous studies have documented the failure of standard antibiotic therapy in patients with Lyme disease. Previous uncontrolled trials and recent placebo-controlled trials suggest that prolonged antibiotic therapy (duration, >4 weeks) may be beneficial for patients with persistent Lyme disease symptoms. Tickborne coinfections may increase the severity and duration of infection with B. burgdorferi.
Conclusions. Prolonged antibiotic therapy may be useful and justifiable in patients with persistent symptoms of Lyme disease and coinfection with tickborne agents.
Received 19 February 2007; accepted 21 February 2007; electronically published 5 June 2007. This is a modified version of a paper presented at the 44th Annual Meeting of the Infectious Diseases Society of America, Toronto, Canada, October 2006.
Clinical Infectious Diseases 2007;45:149-157 � 2007 by the Infectious Diseases Society of America. All rights reserved.
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