- NEW YORK (Reuters Health)
- People with Lyme disease typically take antibiotics for at least 21 days.
However, new research reported Monday suggests some patients may fully
recover with less than half as many days of treatment.
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- The investigators found that people with the most common
form of early Lyme disease, characterized by a rash and, in some cases,
flu-like symptoms, were just as likely to recover whether they took the
antibiotic doxycycline for 10 or 20 days.
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- Moreover, adding another antibiotic to try to combat
the spread of the Lyme disease bacterium to the nervous system appeared
to offer no additional benefit and increased the risk of diarrhea. Lyme
disease is a bacterial infection that is passed to humans from deer ticks.
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- Based on these findings, study author Dr. Gary Wormser
told Reuters Health that all patients with the characteristic "bull's
eye" rash that develops around a tick bite called erythema migrans,
with or without flu-like symptoms, would do just as well on half as many
days of doxycycline alone.
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- "This is by far the majority of patients with early
Lyme" disease, he said.
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- However, for other patients with early stages of Lyme
disease who develop other outward signs of the condition, such as facial
nerve palsy, a longer course of antibiotics may still be needed, said Wormser,
who is based at the New York Medical College and Westchester Medical Center
in Valhalla.
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- But in the case of antibiotics, less is always better,
he noted.
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- "Shorter courses of treatment are safer, less expensive,
and may be less likely to promote emergence of resistant bacteria that
can endanger the entire community," Wormser said in a statement.
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- Lyme disease is most common in the Northeast, parts of
Wisconsin and Minnesota and northern California, although cases have been
reported in other areas.
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- Besides developing a rash, a person bitten by an infected
tick may develop flu-like symptoms. If left untreated, people with the
disease may develop serious complications, including arthritis, heart problems
and meningitis.
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- During the study, reported in the journal Annals of Internal
Medicine, Wormser and his team followed 180 patients with erythema migrans
who received one of three treatments for Lyme disease: 20 days of doxycycline,
10 days of doxycycline or 10 days of the antibiotic plus one intravenous
dose of another antibiotic, ceftriaxone.
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- Three months after treatment ended, between 85 and 90
percent of all patients had fully recovered from the disease, regardless
of which treatment they had received.
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- In one patient given 10 days of doxycycline, the bacterium
spread to the nervous system, causing meningitis. That patient improved
after two weeks of ceftriaxone, an antibiotic that is particularly good
at infiltrating the brain and spinal cord, Wormser said in an interview.
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- In an accompanying editorial, Dr. Allen C. Steere of
the Massachusetts General Hospital in Boston writes that most patients
who do not fully recover with antibiotics -- regardless of the length of
treatment -- had unrecognized neurological symptoms in addition to erythema
migrans.
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- These patients, along with those who have developed arthritis
as a result of Lyme disease, may also require weeks of intravenous treatment
with an antibiotic like ceftriaxone, he notes.
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- SOURCE: Annals of Internal Medicine 2003;138:697-704,761-762.
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