Why This Is Important
The use and duration of antibiotics for chronic Lyme disease treatment is controversial because there is no biomarker that can determine whether the Lyme bacteria has been eradicated in CLD patients. Patients are often told that either chronic Lyme disease does not exist or that it is incurable. If this were true, we would not expect more well and substantially improved patients to be taking antibiotics. Instead, we might have expected the percentage of people using antibiotics to be roughly the same among the patient subgroups.
Concern Over Resistance Other Complications
According to the CDC, it is not known how many people seek treatment for chronic Lyme, or how many complications occur during the course of treatment.
“In addition to the dangers associated with inappropriate antibiotic use, such as selection of antibiotic-resistant bacteria, these treatments can lead to injuries related to unnecessary procedures, bacteremia and resulting metastatic infection, venous thromboses, and missed opportunities to diagnose and treat the actual underlying cause of the patients symptoms,” the authors conclude.
See also:
Hosp: Patient: With: Ivjpg
The Centers for Disease Control and Prevention published five case studies today in Morbidity and Mortality Weekly Report of patients who experienced serious complications and bacterial infections after receiving treatments for “chronic Lyme” disease.
There is no medical definition of “chronic Lyme” and no treatment guidelines instead, the term is used by patients and some providers to describe several symptoms, including fatigue and muscular pain, attributed to prior infection with Lyme disease. Many patients with a chronic Lyme diagnosis, however, test negative for Borrelia burgdorferi, the bacteria associated with the ticks that carry Lyme.
Some practitioners, including alternative medicine professionals who advertise themselves as being “Lyme literate” prescribe long-term courses of antibiotics and immunoglobulin therapy. But the CDC warns that treating an undiagnosed condition with an unregulated treatment plan can be dangerous for patients.
“At least five randomized, placebo-controlled studies have shown that prolonged courses of IV antibiotics in particular do not substantially improve long-term outcome for patients with a diagnosis of chronic Lyme disease and can result in serious harm, including death,” the authors write.
Recommended Reading: Late Stage Lyme Disease Treatment
How Do Patients Respond To Treatment
We looked at patients with chronic Lyme diseasethose who remained ill for six or more months following treatment with antibiotics for Lyme disease . The first thing we did was identify different patients as well, high responders, low responders, or non-responders. Well patients responded positively to a survey question asking if they were well or remained ill. Those who remained ill were asked whether their condition had changed as a result of treatment. Those who said they were unchanged or worse were categorized as non-responders. Patients who said that they were better or worse following treatment, were asked how much better or worse. Those who had improved substantially were deemed high responders.
59% of patients had improved with treatment and 42% were either well or high responders. The focus of our study was on this latter group. You might wonder whether 42% response is considered good compared to other drugs. Heres what the prior head of GlaxoSmithKline said about treatment effectiveness rates of drugs in general .
The vast majority of drugs more than 90 per cent only work in 30 or 50 per cent of the people. Drugs out there on the market work, but they dont work in everybody. Dr. Allen Roses, GlaxoSmithKline
So you can see that a 42% rate of substantial improvement is within the range of most drugs on the market.
Touched By Lyme: Ivs Remain Financial Stumbling Block For Many Lyme Patients
Long-term intravenous antibiotic treatment for Lyme disease is very expensive and often not covered by health insurance. One Wyoming couple found it pays to shop around.
Readers of this blog may remember learning about INFUSING FOR LYMIES, a free e-book written by a Lyme patient about how to save money on IV treatment for Lyme disease. Heres an email I just received from the wife of a Lyme patient:
Just stumbled onto the guide to managing PICC and IV infusion. Wish I had stumbled last October when my husband had a PICC line inserted to hopefully help stem the symptoms of his long undiagnosed Lyme Disease. We live in a 20,000 person county in Wyoming and the local hospital oncology department put in the PICC. They referred the prescription to their usual infusion provider .
Cost per week was $3000!!!!!!! First time I got paperwork I thought they meant per month! I had several conversations with them trying to understand the high cost. They claimed their hands were tied due to contracts with my insurance provider. They furthered this by saying that the contracts were to protect me! I sure didnt feel protected when my insurance refused to pay.
After 2 months I stopped the home health nurses visits at $180 a week. I never wanted to be a nurse but life moves in mysterious ways and a bit of a nurse Ive become.
Also Check: How To Avoid Lyme Disease
Treatment For The Neurological Complications Of Lyme Disease
Review question
Are antibiotics effective for the treatment of Lyme disease affecting the nervous system?
Background
In humans, a bacterium called Borrelia burgdorferi causes Lyme disease. People become infected when bitten by ticks carrying the bacterium. The person may experience symptoms in the joints, skin, muscles, and nervous system , the brain, and the spinal cord). Without antibiotic treatment, neurological Lyme disease either may resolve or cause longterm problems. Neurological Lyme disease differs between Europe and the United States, probably because of differences in B. burgdorferi. Limited information exists about which antibiotics are better for the treatment of neurological Lyme disease.
Study characteristics
Key results and quality of the evidence
The seven studies were too different for their results to be combined, so we analyzed them individually.
None of the studies provided clear evidence that one antibiotic was better than another. One study failed to find evidence that a second and longer treatment with an oral antibiotic offered any extra benefit following initial intravenous treatment with ceftriaxone. As none of the other studies used a dummy treatment , the extra benefit offered by antibiotic treatment over recovery that occurs naturally is unknown. In general, the treatment was tolerated well, although the quality of adverse event reporting in most studies appeared to be low.
The evidence is current to October 2016.
What Factors Determine How Patients Respond To Treatment
To find out what made some patient substantially improve or become well, we turned to our academic partners at the University of California at Los Angeles who specialize in artificial intelligence and machine learning. Their team looked at 215 features related to diagnostic factors, treatment approach, duration of individual antibiotics, alternative treatments, symptoms, type of clinician, and functional impairment to identify the 30 top predictive features for treatment response . Most of the top 30 features identified in their study related to chronic Lyme disease treatment , symptom severity , and type of clinician treating Lyme disease. We analyzed three of these factors associated with treatment response:
- Treatment approach
- Treatment durations
- Type of clinician overseeing the patients care
You May Like: Lyme Disease Diagnosis And Treatment
Intravenous Antibiotics For Lyme: Pros Cons And The Lived Experience
byJennifer Crystalon September 3, 2020
Has your doctor recommended you get a PICC line to treat your Lyme disease? Here are the pros and cons of IV antibiotics for Lyme.
When diagnosed right away, many cases of Lyme disease can be treated with a three-week course of oral antibiotics. Some 20% of patients, however, go on to experience continued symptomsknown as Post Treatment Lyme Disease Syndromeand require more antibiotics. Still others, like myself, suffer with Late Disseminated Lyme Disease, which isnt diagnosed until months or years after a tick bite. By that point, the Lyme bacteria, called a spirochete, has replicated and invaded many systems of the body, often crossing the blood-brain barrier.
This stage of Lyme disease is so advanced that Lyme Literate Medical Doctors often recommend intravenous antibiotics, administered through a peripherally inserted central catheter . A port is placed in your arm with a line that runs directly to your heart. The port remains in your arm for as long as your doctor recommendsin some cases months or even yearsand you self-administer antibiotics. Just the idea of having a PICC line is understandably daunting to patients. Many write to me wondering if they should pursue this route. I responded briefly to this question in one of my Dear Lyme WarriorHelp! columns. In this blog, I will share more about my own experience with a PICC line, and outline pros and cons.
My Experience
Pros
Cons
Treatment For Chronic Lyme Disease
Sometimes, people go through treatment for Lyme disease but their symptoms donât go away. If this lasts over 6 months, itâs known as chronic Lyme disease or âpost-treatment Lyme disease syndromeâ .
Doctors still arenât sure why some people get PTLDS. Some believe that getting Lyme disease may cause damage to your tissues or immune system. Others believe itâs because the bacteria that causes Lyme hasnât completely gone away.
There is little evidence that taking more antibiotics at this stage will help. They may actually be harmful. Instead, your doctor will focus on treating the symptoms youâre still having. This will be different for everyone. Some people could benefit from a medicine that relieves fatigue, while others may need a drug that can help with headaches or very sensitive skin.
Your doctor could also have you try a treatment that helps people with chronic fatigue syndrome or fibromyalgia.
More research is needed to figure out how best to treat PTLDS. Itâs something that can be frustrating. Just remember: Many people who have this condition do start feeling like their old selves after a few months.
Also Check: Lyme Disease How Long Does It Last
Intravenous Antibiotics Injection For Lyme Disease Patients
Lyme disease is an infectious disease caused by the Borrelia bacterium which is spread by ticks. The most common sign of infection is an expanding area of redness on the skin, known as erythema migrants, that appears at the site of the tick bite about a week after it occurred.
In the early stages of Lyme disease, people treated with appropriate antibiotics usually recover rapidly and completely. Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime axetil. However, people with certain neurological or cardiac forms of the illness may require Intravenous Treatment with antibiotics such as ceftriaxone or penicillin.
The antibiotic is administeredthrough a small narrow flexible tube called a catheter or IV line, which isinserted into a vein using a needle. The needle is removed, and the IV line isleft in place and secured by a dressing. There are different types of IV linesavailable, and the one chosen for your treatment will depend on your veins andhow long you will need the antibiotics.
Typical IV therapy consists of a 2- to 4-week course. The patient undergoes a daily antibiotics injection which has been proven to be very effective. However, for some patients, it can be a bit long and discomforting process. A daily injection can represent a nightmare for those patients whose veins are hard to to detect.
Reference:
Oral Antibiotics For Early Treatment Of Lyme
The bacteria involved in spreading Lyme disease throughout the body are intelligent. They find ways to hide in the bloodstream along the lining, making it hard for antibiotics to find and attack. The bacteria are also robust. They can move and replicate even when traveling against the flow of blood.
Plus, to eliminate Lyme bacteria, Borrelia burgdorferi, the bacterias antibodies must be present at the time of antibiotic treatment. This means that if your doctor prescribes antibiotics for two weeks, the bacteria are in hibernation during those two weeks, and they can remain after the treatment ends.
Timing is everything when using oral antibiotics. This becomes even more true for patients who have had Lyme disease for a long time. Oral antibiotics are not as successful when treating late or chronic Lyme disease, plus they can have side effects.
Read Also: Lyme Disease Stages In Humans
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.
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.
You May Like: How To Cure Lyme Disease
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 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.
How Is Lyme Disease Treated
Lyme disease is treated with antibiotics.
The type of antibiotic your doctor gives you and the number of days you take it will depend on your symptoms and the stage of the disease. Talk to your doctor if you have any questions about your antibiotic treatment.
Early treatment
Antibiotic treatment for early Lyme disease works well. Symptoms usually go away within 3 weeks of starting treatment.
The earlier you start this treatment after infection, the faster and more completely you will recover.
It’s important to get treatment for Lyme disease as soon as you can. If it’s not treated, Lyme disease can lead to problems with your skin, joints, nervous system, and heart. These can occur weeks, months, or even years after your tick bite. The problems often get better with antibiotics. But in rare cases, they can last the rest of your life.
Later treatment
If the disease gets worse, treatment options include:
People with partial facial paralysis as a result of Lyme disease may improve on their own without more treatment.
Even after successful treatment for Lyme disease, you can get it again. So it’s important to keep protecting yourself against tick bites.
Recommended Reading: New York Times Lyme Disease
Description Of The Condition
Lyme neuroborreliosis is a group of diseases that can affect the central nervous system and the peripheral nervous system , or both, as a result of infection with or the postinfectious consequences of different species of the spirochete bacterium Borrelia burgdorferi. These organisms are transmitted by ixodid ticks in endemic areas in the United States and Europe. Although a multitude of clinical manifestations of LNB have been reported, the most common are radicular pains, facial paralysis, and meningitis, referred to as Bannwarth’s syndrome in Europe . It was not until 1981 that entomologist Willy Burgdorfer and colleagues in the United States suspected that the cause of Lyme disease was a tickborne spirochete . In the decades since the identification of B. burgdorferi, it has become clear that LNB is one of the most common and important complications of Lyme disease. The diagnosis of LNB requires confirmation of infection with B. burgdorferi plus evidence of involvement of the CNS, the PNS, or both. According to the Centers for Disease Control and Prevention, from the 154,405 cases of Lyme disease reported during 2001 to 2010 in the United States, 14% were identified with facial palsy, radiculoneuropathy, meningitis, or encephalitis . Looking at Lyme disease occurring in Europe, others have estimated that up to 12% of cases have neurological manifestations , and that approximately 5% of individuals with an untreated erythema migrans will develop LNB .
Picc Line For Lyme Disease:
PICC stands for peripherally inserted central catheter. Inserting a PICC line is a common procedure in which a thin, flexible tube will be inserted into a large vein in the upper arm. The tube will be threaded through the vein until it rests just above the heart. A technician will use a numbing agent so there is no pain and the tube will be guided through the vein with the help of ultrasound and/or X-ray. A PICC line can stay in place for several weeks or months without needing to be changed or taken out. It is a more effective way of delivering IV antibiotics into your body if you intend to be using them on a regular basis. The placement of the tube just above the heart allows for a quicker response time for medications and nutrients, etc. If done properly, once the line is in and the initial discomfort settles, it shouldnt be at all noticeable.
Each infusion with a PICC line will take anywhere from 30 minutes to an hour and a half and can be done at your own home either on your own or via a visiting nurse. Otherwise, infusions will be done at a hospital infusion lab or doctors office. PICC lines require regular cleaning by a nurse, either in home or at a facility.
This procedure should be taken seriously and adequate discussion and caution should be used when considering a PICC line with your doctor.
Also Check: What Is The Effects Of Lyme Disease