Duration of Antibiotic Therapy for Early Lyme Disease

@article{Wormser2003DurationOA,
  title={Duration of Antibiotic Therapy for Early Lyme Disease},
  author={Gary P. Wormser and Roshan Ramanathan and John Nowakowski and Donna McKenna and Diane Holmgren and Paul Visintainer and Rhea L. Dornbush and Brij Nandan Singh and Robert B. Nadelman},
  journal={Annals of Internal Medicine},
  year={2003},
  volume={138},
  pages={697-704}
}
Context Optimal antibiotic treatment for patients with early Lyme disease is unclear. Contribution This single-center randomized, double-blind, placebo-controlled trial found that patients with erythema migrans given any of the follwoing regimens had high response rates, defined as resolution of erythema migrans and symptoms at 30 months: 20 days of doxycycline, 83.9%; 10 days of doxycycline, 90.3%; and 10 days of doxycycline plus a single intravenous dose of ceftriaxone, 86.5%. Patients given… 

Antibiotic treatment duration and long-term outcomes of patients with early lyme disease from a lyme disease-hyperendemic area.

TLDR
Patients treated for 10 days with antibiotic therapy for early Lyme disease have long-term outcomes similar to those of patients treated with longer courses, and treatment failure after appropriately targeted short-course therapy, if it occurs, is exceedingly rare.

Duration of Antibiotic Therapy for Lyme Disease

  • A. Steere
  • Medicine
    Annals of Internal Medicine
  • 2003
TLDR
The duration of antibiotic therapy for erythema migrans has been reconsidered, showing conclusively that the overall outcome was similar in those treated with either 10- or 20-day courses of oral doxycycline, a tetracycline congener, or with one dose of intravenous ceftriaxone followed by doxy cycline for 10 days.

Treatment of erythema migrans with doxycycline for 10 days versus 15 days.

TLDR
The 10-day regimen of oral doxycycline was not inferior to the 15- day regimen among adult European patients with solitary erythema migrans and the frequency of nonspecific symptoms after treatment was similar to that among control subjects.

Efficacy of Short-Term High Dose Pulsed Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome (PTLDS) and Associated Co-Infections: A Report of Three Cases and Literature Review

TLDR
High dose pulsed dapsone combination therapy may represent a novel therapeutic approach for the treatment of resistant CLD/PTLDS, and should be confirmed in randomized, controlled clinical trials.

Persistent Lyme Empiric Antibiotic Study Europe (PLEASE) - design of a randomized controlled trial of prolonged antibiotic treatment in patients with persistent symptoms attributed to Lyme borreliosis

TLDR
The results of this study may provide evidence for prescribing or withholding prolonged antibiotic treatment, and the background and design issues of the PLEASE study protocol are described.

Oral doxycycline versus intravenous ceftriaxone for treatment of multiple erythema migrans: an open-label alternate-treatment observational trial

TLDR
The 14 day oral doxycycline was not inferior to the 14’day intravenous ceftriaxone in treatment of adult European patients with early disseminated Lyme borreliosis manifested as multiple EM, and the frequency of non-specific symptoms in patients was similar to that in controls.

Diagnostic challenges of early Lyme disease: Lessons from a community case series

TLDR
Failure to recognize erythema migrans or alternatively, viral-like presentations without a rash, can lead to missed or delayed diagnosis of Lyme disease, ineffective antibiotic treatment, and the potential for late manifestations.
...

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TLDR
In patients with acute disseminated Lyme disease but without meningitis, oral doxycycline and parenterally administered ceftriaxone were equally effective in preventing the late manifestations of disease.

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TLDR
There is considerable impairment of health-related quality of life among patients with persistent symptoms despite previous antibiotic treatment for acute Lyme disease, and treatment with intravenous and oral antibiotics for 90 days did not improve symptoms more than placebo.

Comparison of cefuroxime axetil and doxycycline in treatment of patients with early Lyme disease associated with erythema migrans

TLDR
Cefuroxime axetil is well tolerated and appears to be equally as effective as doxycycline in the treatment of early Lyme disease and in preventing the subsequent development of late Lyme disease.

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TLDR
For patients with early Lyme disease, tetracycline appears to be the most effective drug, then penicillin, and finally erythromycin; with all three antibiotic agents nearly half of the patients had minor late symptoms such as headache, musculoskeletal pain, and lethargy.

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  • G. Wormser
  • Medicine, Biology
    The Mount Sinai journal of medicine, New York
  • 1995
TLDR
There is no convincing evidence for extending treatment of early Lyme disease beyond 14 days, and there is also no evidence that longer therapy is more efficacious for other manifestations of Lyme disease, although this issue deserves further study.

Lyme disease: insights into the use of antimicrobials for prevention and treatment in the context of experience with other spirochetal infections.

TLDR
There is no convincing evidence for extending treatment of early Lyme disease beyond 14 days, and there is also no evidence that longer therapy is more efficacious for other manifestations of Lyme disease, although this issue deserves further study.

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TLDR
A large, multicenter, double-blind, randomized trial on the treatment of Lyme disease with azithromycin, an azalide (a new subclass of macrolide antibiotics), chosen as the comparative agent to circumvent the problems associated with sun-related hypersensitivity reactions.

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TLDR
It is concluded that a single oral dose of 500 mg of tetracycline or erythromycin is optimal therapy for B. recurrentis infection.

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TLDR
B burgdorferi can invade the CNS early in the course of infection, and careful consideration should be given to choosing antibiotics that achieve adequate CSF levels in patients with disseminated infection.