The Treatment Of Early Lyme Disease
Christie Choo-Kang, PharmD, BCPSNephrology and Renal Transplant Clinical SpecialistBoston Medical Center
Eileen Tang, PharmD Candidate 2011College of Pharmacy and Allied Health Professions, St. John’s UniversityNew York, New York
Arun Mattappallil, PharmD Candidate 2011College of Pharmacy and Allied Health Professions, St. John’s UniversityNew York, New York
US Pharm.
Lyme disease, also known as Lyme borreliosis, is the most common vector-transmitted illness in the United States.1,2 The disease was first recognized in 1975 in a number of children in Lyme, Connecticut, who were initially diagnosed with juvenile rheumatoid arthritis because of overlapping signs and symptoms.1 In 1982, Willy Burgdorfer, PhD, discovered that a spirochete isolated from Ixodes scapularis, a deer tick, was the same spirochete found in patients with Lyme disease.
Confirmed cases of Lyme disease are defined as erythema migrans greater than 5 cm in diameter or one or more objective late manifestations of Lyme disease with laboratory confirmation in patients with possible exposure to ticks. Healthy People 2010 set a goal of a 44% decrease in the incidence of Lyme disease by 2010. Since 2000, the CDC has contributed more than $3.5 million per year for new research on Lyme disease.2
What You Should Know About Blacklegged Tick Bites
When it comes to Lyme and other tick-borne illness, prevention is the best form of medicine. When spending time in areas where ticks may be present, wear long sleeves and pants, tuck your pants into your socks, and wear tick repellent containing DEET, picaridin, IR3535, or oil of lemon eucalyptus. Pretreat outdoor clothing and gear with permethrin, an insecticide that kills ticks on contact. Clothing can be treated at home with sprays or dips that are effective for 2-6 weeks . Always check yourself for ticks after each potential exposure check pets, even those treated with tick repellents, after every trip outside. For more on tick bite prevention, see our Lyme brochure.
If you are bitten by a tick, here is information you should have.
The information below is for educational purposes only. It is not intended to replace or supersede patient care by a healthcare provider. If you suspect the presence of a tick-borne illness, you should consult a healthcare provider who is familiar with the diagnosis and treatment of tick-borne diseases.
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.
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How Lyme Disease Guidelines Are Set To Change
Rachael Zimlich, RN, BSNContemporary PEDS Journal
The guidelines for diagnosing and treating Lyme disease may soon be changing, although pediatricians aren’t expected to readily adopt all the recommendations.
The guidelines for diagnosing and treating Lyme disease may soon be changing, although pediatricians aren’t expected to readily adopt all the recommendations.
Closed in September, the comment period closed on a new set of guidelines for the prevention, diagnosis, and treatment of Lyme disease. The guidelines have several updates, but one of the primary changes is the recommendation to use doxycycline for treatment of Lyme disease infection and as prophylaxis after a high-risk tick bite-even in children. Pediatricians, however, are not used to using doxycycline in children due to concerns about damage and staining to teeth, and the authors of the guidelines anticipate pediatricians will hesitate to adopt the change, opting instead to continue prescribing other antibiotics.
The infection process for Lyme disease is clinically complex, with a wide range for the latent period after exposure and before an infection presents. Symptoms of Lyme infection may include localized skin lesions at the site of the bite, neuropathy, meningitis, cardiac conduction problems, and arthritis. Manifestations can occur as early as a few days after a tick bite, to as late as several months after.
What Are The Side Effects Of Doxycycline In Dogs
The most common side effects of Doxycycline are vomiting, diarrhea, loss of appetite, weight loss, and drowsiness. In addition to these adverse GI effects, on rare occasions, Doxycycline may cause more severe side effects such as:
- Jaundice
- Trouble swallowing
- Bleeding
- Behavioral changes.
Interestingly, Doxycycline increases the skins sunlight sensitivity making it more susceptible to sunburns, especially on hairless areas like the nose, ears, and eyelids.
Plus, it can impair normal growth and cause teeth discoloration hence it cannot be used in growing puppies, pregnant, and lactating females.
Obviously, Doxycycline must not be used in dogs allergic to tetracycline antibiotics, and its use requires extra caution in pets with impaired kidney and liver function.
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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:
- Red meat
- Tightness in chest or throat
- Swelling of face, lips, or tongue
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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Lyme Disease Antibiotic Treatment Research
For early Lyme disease, a short course of oral antibiotics, such as doxycycline or amoxicillin, cures the majority of cases. In more complicated cases, Lyme disease can usually be successfully treated with three to four weeks of antibiotic therapy.
After being treated for Lyme disease, a minority of patients may still report non-specific symptoms, including persistent pain, joint and muscle aches, fatigue, impaired cognitive function, or unexplained numbness. These patients often show no evidence of active infection and may be diagnosed with post-treatment Lyme disease syndrome .
Multiple clinical trials, funded by NIH and others, have shown no benefit to additional IV antibiotic treatment in patients with Lyme disease, although the interpretation of those results have been challenged by some.
Lyme Disease Treatment Doxycycline Side Effects
Most patients respond well to this medication. However, doxycycline is known to cause photosensitivity in some people so use of sunscreen is a must. Also avoid strong sunlight exposure as far as possible. To prevent acidity, headaches and nausea it is advisable to drink a tall glass of water with the medicine. Also take the drug with food.
Medicines like amoxicillin and cefuroxime are associated with rashes, diarrhea and other health effects.
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Dosage Of Doxycycline For Dogs
Dosing of doxycycline for dogs is different depending on the infection.
For general infections, doxycycline is given 3-5 mg/kg orally every 12 hours for 7-14 days.
For infections of the urinary tract and soft tissue infection, wounds that wont heal, doxycycline is given 4.4-11 mg/kg orally every 12 hours for 7-14 days.
For acute infections with Ehrlichia Canis, doxycycline is given in two schemes, depending on the clinical symptoms of the dog, either 5mg/kg orally every 12 hours for 14-16 days or 10mg/kg orally every 24 hours for 14-16 days.
For chronic infections with Ehrlichia Canis, doxycycline is given10 mg/kg orally every 24 hours for 30-42 days.
For the treatment of granulocytic anaplasmosis in dogs, doxycycline is given 5 mg/kg orally every 12 hours for 14 days.
For the treatment of Lyme disease, doxycycline is given 10 mg/kg orally every 24 hours for 21-28 days.
For the treatment of Leptospirosis, doxycycline is given 5-10 mg/kg orally every 12 hours for 14 days.
These diseases are the main reasons veterinarians prescribe doxycycline for dogs. Be aware that this is a potent and heavy drug, and you must comply with all directions on how to give the antibiotic provided by your veterinarian.
Selection Criteria And Methods
One reviewer screened citations and selected studies. In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved and assessed for inclusion. The final selection of full-text articles was based on the inclusion criteria presented in .
Selection Criteria.
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Hunting For Alternative Drug
Frustrated by the lack of treatment options for Lyme disease patients with lingering symptoms, Rajadas and his team began hunting for a better alternative in 2011. In 2016, they published a study in Drug Design, Development and Therapy that listed 20 chemical compounds, from about 4,000, that were most effective at killing the infection in mice. All 20 had been approved by the Food and Drug Administration for various uses. One, for instance, is used to treat alcohol abuse disorder.
Jayakumar Rajadas
In this most recent study, azlocillin, one of the top-20 contenders, was shown to eclipse a total of 7,450 compounds because it is more effective in killing B. burgdorferi and causes fewer side effects. Lyme disease affects more than 300,000 people annually, according to the Centers for Disease Control and Prevention. It can affect various organs, including the brain, skin, heart, joints and nervous system, and cause heart problems and arthritis if untreated. Symptoms include fever, headaches, chills, and muscle and joint pain.
Traditional antibiotics, such as doxycycline, are effective as an early course of treatment for the infection in the majority of patients, but it remains unclear why these drugs fail to treat 10% to 20% of patients, Rajadas said.
Critical Appraisal Of Individual Studies
The included systematic review was critically appraised by one reviewer using AMSTAR II, the non-randomized study was assessed using the ROBINS-I Tool, and guidelines, were assessed with the AGREE II instrument. Summary scores were not calculated for the included studies rather, a review of the strengths and limitations of each included study were described narratively.
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If I Take Antibiotics To Prevent Lyme And Then Have A Negative Test Am I Lyme
If you do receive prophylactic treatment, be cautious in in interpreting the results of subsequent testing. Widely-used blood tests look for antibodies to Borrelia burgdorferi, but early treatment can prevent the body from mounting an antibody response. Should you become infected despite prophylactic treatment, subsequent tests results couldbe falsely negative.
What Does Current Guidance Say On This Issue
NICE guidance on Lyme disease states that those without focal symptoms should receive 100mg oral doxycycline twice a day or 200mg once per day for 21 days. The first alternative to this is oral amoxicillin, 1g three times per day for 21 days and the second alternative is oral azithromycin, 500mg daily for 17 days.
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Is Amoxicillinas Effective As Doxycycline For Lyme Disease
You might be askingyourself, Can amoxicillin treat Lyme disease? The answer is yes. Anamoxicillin treatment for early Lyme disease is widely prescribed, but foramoxicillin to have the same efficacy as doxycycline, patients will have totake almost 10 times the amount 500 mg three times a day, for two to threeweeks. Deciding which antibiotic to go with depends on the patients ability tokeep up with the antibiotics course and how far along the disease hasprogressed.
Amoxicillin is alsoprescribed in patients who are pregnant because its still effective againstthe bacteria but doesnt pose the same risks as doxycycline on the pregnancyand unborn child. Doxycycline is also avoided in children under eight yearsold, whereas amoxicillin can be taken by children who have been infected withLyme.
Doxycycline Dosage For Lyme Disease Prevention
You have been bitten by a tick and do not know what to do? First of all, visit your doctor. He will propose an appropriate treatment that will help to prevent Lyme disease.However, not every doctor knows how to treat this disease in the early and late stages. So what is the doxycycline dosage for Lyme disease prevention after being bitten by a tick?
When a patient who has been recently bitten by a tick reports to a doctor, the doctor usually prescribes doxycycline at a dose of 200mg per day, divided into two portions 100mg in the morning and 100mg in the evening. Is this, however, a sufficient dose to stop the possible spread of Lyme disease in our body?
In this article, we will focus on the treatment proposed by the International Lyme and Associated Diseases Society . As well as for the treatment of fresh Lyme disease or doxycycline therapy just after a tick bite to prevent disease.
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What Is Doxycycline
Doxycycline is an antibiotic from the tetracycline group commonly used in veterinary medicine to treat a variety of conditions and diseases in dogs and cats. Tetracyclines are a group of broad-spectrum antibiotics, and they all have a similar basic compound.
Tetracyclines are either isolated from Streptomyces bacteria directly or semi-synthetically from the isolated compounds. This group of antibiotics was discovered in the 1940s. At the moment, on the market, there are no veterinary-approved products, but veterinarians are prescribing 100mg capsules, 50mg tablets, or 25mg oral suspension of doxycycline for dogs.
In domestic animals, doxycycline for dogs is used to treat microorganisms such as Borrelia, Leptospira, Rickettsiae, Chlamydia, Mycoplasma, Bartonella, and Bordetella.
All tetracyclines act as a bacteriostatic by inhibiting the protein synthesis of the ribosomes, and by altering the permeability of the cytoplasmatic membrane of the susceptible organisms.
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.
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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.
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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