Summary Of Study Characteristics
Additional details regarding the strengths and limitations of included publications are provided in .
Systematic Review with Meta-Analysis
The review is unclear regarding whether study selection was conducted in duplicate if the reviewers did not conduct study selection in duplicate then this could introduce bias into the review, with reduced quality and confidence in its results. Grey literature was not searched and content experts were not consulted, which may have omitted relevant data and introduced publication bias. This omission is of particular importance since publication bias was not assessed. The sources of funding for each included trial were not discussed and risk of bias from the selection of the reported result from multiple measurements or analyses was not assessed. These review characteristics may increase bias in: study selection search strategy risk of bias assessments and their impact on the meta-analysis, interpretation of results, and discussion sources of funding and conflicts of interest, which therefore decrease the confidence in the results of the systematic review.
Outcome measurement may have been influenced by knowledge of received intervention since the outcome assessors were aware of the intervention received by study participants and may therefore decrease confidence in the results of the study.
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Study Design And Interventions
The study is a randomised, double-blinded, placebo-controlled, multicentre trial with a non-inferiority design. We plan to recruit 120 patients diagnosed with definite or probable LNB according to EFNS guidelines at six different hospitals in the southern part of Norway as shown in . The study is coordinated from Sørlandet Hospital in Kristiansand, Agder County by neurologists connected to the large BorrSci study . The inclusion and exclusion criteria are shown in . Inclusion started in 2015 and will continue through December 2019 or until the necessary sample size is obtained. Eligibility before inclusion is assessed by, or discussed with, a physician connected to the study and accustomed to evaluating patients with neurological symptoms. The patients are randomised into two treatment arms: doxycycline 200mg daily for 2 weeks, followed by 4weeks of placebo doxycycline 200mg daily for 6weeks .
Neurological symptoms suggestive of Lyme neuroborreliosis without other obvious reasons, and one or both of
CSF pleocytosis .
Intrathecal Borrelia burgdorferi antibody production.
Signed informed consent.
Treatment with cephalosporin, penicillin or tetracycline macrolide during the last 14days before start of doxycycline treatment.
Pregnancy, breast feeding and/or women of childbearing potential not using adequate contraception.
Adverse reaction to tetracyclines.
Serious liver or kidney disease that contraindicates use of doxycyline.
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What Did It Find
- Compared to doxycycline, there was no difference between the following antibiotics for treatment response by 12 months: penicillin V , azithromycin , cefuroxime axetil , amoxicillin or ceftriaxone plus doxycycline .
- More than 80% of patients showed a treatment response, 84% at two or fewer months after starting treatment and 80% at 12 or more months following treatment initiation. There was no available data on outcomes for around 15%.
- There were few treatment failures in those people who were followed up 4% by two months and 2% by 12 months.
- Treatment-related adverse effects occurred in around 31% of people and included vomiting and diarrhoea as well as a Herxheimer-like reaction . Only 1% experienced haematologic adverse events, such as low platelet counts.
For Memory Concentration And Focus
Improving memory is a challenge. In Lyme disease, short-term memory problems and word-retrieval problems are common. These often improve substantially with appropriate antibiotic therapy. Over time, most patients regain their cognitive function.
When memory is a problem, consider that this could be due to a primary problem with attention or with mood. An individual who can’t focus won’t be able to remember because he/she didn’t “attend” to the item in the first place. This happens to all of us when we hear someone’s name at a party if we don’t focus on the name and perhaps make a mental association to the name to enhance memory storage, we will forget that name within minutes. Patients with depression often experience problems with memory and verbal fluency when the depression is resolved, the memory and verbal fluency typically resolve as well.
- Medications: Attention can be improved with certain medications, such as bupropion , atomoxetine , modafinil , or stimulants . Medications that temporarily slow cognitive decline in Alzheimer’s disease or memantine ) have not been studied in Lyme disease.
- There is some evidence that online brain training programs can enhance concentration or processing speed.
- Neurofeedback may be helpful in improving attention, as well as in improving sleep and reducing pain. This has been studied for migraines, fibromyalgia, and ADHD.
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Awareness Of Lyme Disease
1.1.1 Be aware that:
the bacteria that cause Lyme disease are transmitted by the bite of an infected tick
ticks are mainly found in grassy and wooded areas, including urban gardens and parks
tick bites may not always be noticed
infected ticks are found throughout the UK and Ireland, and although some areas appear to have a higher prevalence of infected ticks, prevalence data are incomplete
particularly high-risk areas are the South of England and Scottish Highlands but infection can occur in many areas
Lyme disease may be more prevalent in parts of central, eastern and northern Europe and parts of Asia, the US and Canada.
1.1.2 Be aware that most tick bites do not transmit Lyme disease and that prompt, correct removal of the tick reduces the risk of transmission.
1.1.3 Give people advice about:
where ticks are commonly found
the importance of prompt, correct tick removal and how to do this
covering exposed skin and using insect repellents that protect against ticks
how to check themselves and their children for ticks on the skin
sources of information on Lyme disease, such as Public Health England’s resources and guidance on Lyme disease and organisations providing information and support, such as patient charities.
For a short explanation of why the committee made the recommendations and how they might affect practice, see the rationale and impact section on awareness of Lyme disease.
How Quickly Will Doxycycline Work
Once taken orally, doxycycline peaks within 1.5 to 4 hours with immediate release and 2.8 to 3 hours with extended-release capsules. Treatment guidelines suggest that doxycycline works better if you take it on an empty stomach, therefore it is suggested that doxycycline be administered on an empty stomach 1-2 hours before meals.
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Guidelines With Unclear Methodology
- CHEO. Prophylaxis of Lyme disease in pediatric patients. 2018.
- MukkadaS, BuckinghamSC. Recognition of and prompt treatment for tick-borne infections in children. Infect Dis Clin North Am. 2015 29:539555.
- OnyettH. Lyme disease in Canada: focus on children. Paediatr Child Health. 2014 19:379388.
- SmithGN, GemmillI, MooreKM. Management of tick bites and lyme disease during pregnancy. J Obstet Gynaecol Can. 2012 34:10871091.
- SzulzykT, FlisiakR. Lyme borreliosis. Ann Parasitol. 2012 58:6369.
- LopezSMC, CampfieldBT, NowalkAJ. Oral management for pediatric Lyme meningitis. J Pediatric Infect Dis Soc. 2018.
Is 10 Days Of Doxycycline Enough
Ten days of doxycycline therapy is usually enough for patients with the erythema migrans rash. With such treatment, most patients have satisfactory outcomes. ACP (Internal Medicine.
How many days should you take doxycycline?
Adults and children weighing 45 kilograms or more100 milligrams two times a day for 60 days. Children weighing less than 45 kgDose is based on body weight and must be determined by your doctor.
Can doxycycline make you extremely tired?
Serious side effects are rare and happen in less than 1 in 1,000 people. Contact 111 or call a doctor now if you have: bruising or bleeding you cannot explain , a sore throat, high temperature and feeling tired or generally unwell these can be signs of blood problems.
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Azlocillin Comes Out On Top
The drug, which is not on the market, was tested in mouse models of Lyme disease at seven-day, 14-day and 21-day intervals and found to eliminate the infection. For the first time, azlocillin was also shown to be effective in killing drug-tolerant forms of B. burgdorferi in lab dishes, indicating that it may work as a therapy for lingering symptoms of Lyme disease.
Pothineni and Rajadas have patented the compound for the treatment of Lyme disease and are working with a company to develop an oral form of the drug. Researchers plan to conduct a clinical trial.
Rajadas is also a professor of bioengineering and therapeutic sciences at the University of California-San Francisco.
Other Stanford co-authors are Hari-Hara S. K. Potula, PhD, senior research scientist postdoctoral scholars Aditya Ambati, PhD, and Venkata Mallajosyula, PhD senior research scientist Mohammed Inayathullah, PhD and intern Mohamed Sohail Ahmed.
A researcher at Loyola College in India also contributed to the work.
The study was funded by the Bay Area Lyme Foundation and Laurel STEM Fund.
Context And Policy Issues
Lyme disease affected 2025 Canadians in 2017, making it the most common vector-borne infection in Canada., Immature black-legged ticks Ixodes scapularis in Eastern and Central Canada or I. pacificus in British Columbia infected with the bacteria spirochete Borrelia burgdorferi are responsible for transmitting Lyme disease to humans in Canada. Erythema migrans, fever, and arthralgia are the diagnostic triad for Lyme disease.
In Canada, Lyme disease became a nationally reportable disease in 2009 with black-legged ticks confirmed in sections of British Columbia, Manitoba, Ontario, Quebec, New Brunswick and Nova Scotia. However, half of reported Lyme disease cases in Canada were caused by infected ticks encountered during travel to the eastern United States and Europe.
For adults, a single dose of doxycycline has been recommended for prophylaxis after tick attachment for prevention of Lyme disease.,,, For children eight years of age and older, a single dose of doxycycline ., Doxycycline is contraindicated in pregnant or lactating women as well as in young children due to the risk of possible effects on fetus bone formation and permanent tooth staining.
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Doxycycline For Tick Bite
Tessa Chatham Registered Nurse
Tessa Chatham Registered Nurse
Tessa is a MSN prepared Registered Nurse with 10 years of critical care experience in healthcare. When not practicing clinical nursing, she enjoys academic writing and is passionate about helping those affected by medical aliments live healthy lives.
Linda Anegawa MD, FACP
Linda Anegawa MD, FACP
Dr. Anegawa graduated from the Univ. of Pennsylvania School of Medicine and completed residency at Stanford. She has over 20 years of practice experience and specializes in Internal Medicine and Obesity Medicine.
What Is The Best Time Of Day To Take Doxycycline
The best time of day to take doxycycline is 1 to 2 hours before meals. Some doxycycline prescriptions are prescribed twice a day, once in the morning and once in the evening. It is best to take these 1 to 2 hours before meals. For example, if you eat breakfast at 9:00 am, then it is best to take the dose between 7 and 8 am. If you usually eat dinner at 7:00 pm, then you should take the dose between 5 and 6 pm.
Taking doxycycline with a meal can decrease its effectiveness and decrease serum levels in the body. This means that if taken with a high-fat meal or milk, it may not work as intended and fight bacteria unsuccessfully. In addition, if you take oral contraceptives for birth control, doxycycline may cause your birth control to be less effective, so a back-up method is recommended while taking doxycycline.
Administration with iron or calcium may also decrease absorption of doxycycline. Food with high iron and calcium include:
- Tightness in chest or throat
- Swelling of face, lips, or tongue
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Delayed Diagnosis Prolonged Symptoms
People often dont realize that a tick has bitten them. Or they may not develop the characteristic bullseye-shaped rash that would lead them to seek medical care sooner.
So, weeks or months may have passed by the time people show up at the doctors office with more severe symptoms, such as heart problems, headaches, pain, or weakness.
Study author Monica Embers, PhD, assistant professor of microbiology and immunology at Tulane University School of Medicine, said in a press release that although antibiotics help many people with Lyme disease, standard treatment may not be enough when diagnosis is delayed.
Dr. Samuel Shor, president of the International Lyme and Associated Diseases Society, points to the study as evidence that a low-level persistent infection may be behind the long-term symptoms that some people treated for Lyme disease experience.
The problem is that the organism has the potential capacity to continue to infect multiple areas of the body and ultimately result in what we characterize now as chronic Lyme disease, Shor told Healthline.
As officials at the Centers for Disease Control and Prevention point out, chronic Lyme disease is a term that is not used the same by everyone.
Its often used to describe lingering symptoms after Lyme disease treatment. But some people also use it to describe those symptoms even when there is no evidence that a person has had a B. burgdorferi infection.
Fatigue, in particular, is a difficult symptom to study in animals.
Don’t Let Lyme Stop You
Lyme Disease is one of the most misunderstood diseases. So misunderstood, in fact, that even doctors have a difficult time detecting and diagnosing Lyme Disease. Furthermore, once it has been diagnosed, there isn’t a clear treatment protocol for doctors to follow. That’s why you need to choose a medical clinic with Lyme Disease specialists who understand the difficulty of living with this disease.
Our medical detectives have years of experience in identifying this disease where other doctors have failed, and in treating even the most trying cases. Don’t settle for doxycycline find real relief with our clinic today. For more information on Lyme Disease, or to schedule a consultation, contact us at Serenity Health Care in Milwaukee, Wisconsin.
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Does Doxycycline Kill Ticks
Doxycycline does not kill ticks but treats illnesses caused by tick bites. Doxycycline is an antibiotic that kills a wide variety of bacteria and parasites but does not kill ticks directly.
Chemicals that kill ticks directly are not safe for human consumption. Pesticides and insecticides can kill ticks instantly but are not safe to put on skin or handle without gloves. Usually, these chemicals are sprinkled along the yard to kill ticks and other insects.
What Are The Side Effects Of Lyme Disease Treatments
Antibiotics, like all medications, have the potential for side effects. Any antibiotic can cause skin rashes, and if an itchy red rash develops while on antibiotics, a patient should see their physician. Sometimes symptoms worsen for the first few days on an antibiotic. This is called a Herxheimer reaction and occurs when the antibiotics start to kill the bacteria. In the first 24 to 48 hours, dead bacterial products stimulate the immune system to release inflammatory cytokines and chemokines that can cause increased fever and achiness. This should be transient and last no more than a day or two after the initiation of antibiotics.
The most common side effect of the penicillin antibiotics is diarrhea, and occasionally even serious cases caused by the bacteria Clostridium difficile. This bacterial overgrowth condition occurs because antibiotics kill the good bacteria in our gut. It can be helpful to use probiotics to restore the good bacteria and microbiome balance.
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What Did This Study Do
This network meta-analysis included 19 randomised controlled trials involving 2,532 people with erythema migrans due to Lyme disease. No trials were based in the UK most were from the United States or Europe.
Each trial compared two or three antibiotics. Doxycycline was the most frequently used antibiotic. A number of doses and treatment durations were represented. For example, treatment length for doxycycline ranged from 10 to 21 days. For the main analyses, doxycycline was used as the reference treatment.
Both direct and indirect data were extracted from the studies. This approach is helpful when there is a shortage of head to head research, but this, and the overall low quality of included studies means that results need to be treated with some caution.
Is Doxycycline Or Amoxicillin Better For Treating Lyme Disease
Lyme disease is atick-borne illness caused by the family of Borrelia bacteria. When aninfected tick transfers the disease via bite to a living host, the bacteriamakes its way through the body to organs and tissues and wreaks havoc on thenervous system and proper function of the heart, brain, muscles, and joints.
The early symptoms of Lymepresent themselves as flu-like and include headache, fatigue, muscle and jointaches, and a bullseye rash at the site of the bite. As the disease progresses,the symptoms become more severe and can include cardiac issues such asarrythmia, lowered cognitive function, chronic fatigue, and pain in the jointsand muscles. There is only one treatment available for ridding the body of theBorrelia bacteria, and thats antibiotics.
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What Is The Treatment For Lyme Disease
The first-line standard of care treatment for adults with Lyme disease is doxycycline, a tetracycline antibiotic. Other antibiotics that have activity against borrelia include the penicillin-like antibiotic, amoxicillin, and the second generation cephalosporin, Ceftin. The mainstay of treatment is with oral antibiotics, but intravenous antibiotics are sometimes indicated for more difficult to treat cases of neurologic-Lyme disease, such as meningitis, and cases of late Lyme arthritis.