Lyme Disease Treatable
With Fewer Antibiotics

By Alison McCook

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.
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.
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.
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.
"This is by far the majority of patients with early Lyme" disease, he said.
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.
But in the case of antibiotics, less is always better, he noted.
"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.
Lyme disease is most common in the Northeast, parts of Wisconsin and Minnesota and northern California, although cases have been reported in other areas.
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.
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.
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.
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.
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.
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.
SOURCE: Annals of Internal Medicine 2003;138:697-704,761-762.



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