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Lyme Disease and Post-treatment Lyme Disease Syndrome: Current and Developing Treatment Options

The consensus shows that current treatments, including the use of antibiotics such as doxycycline, cefuroxime, and others, are the most clear-cut choices. However, with PTLDS affecting up to 20% of those with Lyme disease, more options are needed to prevent Lyme disease or treat PTLDS to help patients. The most promising options include actively developing vaccinations such as VLA15 and antibiotics such as hygromycin A and azlocillin, which are being investigated for safety and efficacy. Moreover, each of these options allows researchers to explore better options for Lyme disease treatment and also more insight into the true root cause of PTLDS.

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 Watch out for Lyme Disease!

Prophylaxis may be administered to adults and children but must satisfy a list of requirements to be administered including proper tick identification and tick attachment >36 hours. The drug of choice is doxycycline if not contraindicated. Treatment options for early localized infection, early disseminated, lyme meningitis, and cardiac disease generally involve doxycycline or amoxicillin and have risk for developing a Jarisch-Herxheimer reaction within the first 24 hours with symptoms of fever, chills, tachycardia, and myalgias

 When It Comes to Ticks, It’s Okay to Make RASH Decisions

Erythema migrans is an expanding skin lesion that is commonly seen in the earliest stages of Lyme disease. It is estimated to occur in 70-80% of infected persons. The rash begins at the site of the tick bite but may not show up until 3-30 days later. It is classically described as a “target” or bulls-eye shaped, circular, red rash with central clearing but can take different forms. In fact, only 20-30% of erythema migrans appear as the classic, target shaped, lesion. The rash may also present as a large red plaque with or without central clearing, or as a red-blue rash resembling a bruise. The rash is generally not painful or pruritic. All patients who live in Lyme-endemic areas who are identified to have the erythema migrans rash should be presumed to have Lyme disease and may be treated empirically.

Articles of Interest

Disseminated Lyme

Our patient is started on twice daily doxycycline, and improvement in his rash and systemic symptoms is seen during his two-day hospital stay. He is discharged home with doxycycline to complete his 21 day course.

EM@3AM: Lyme Disease

A tick infected with B. burgdorferi may not necessarily transmit disease unless it has been feeding for greater than 36 hours. If the tick has been attached for greater than 36 hours then prophylaxis is recommended whether the tick is infected or not.

Episode 168.0 – Lyme Disease

Amoxicillin (500 mg PO TID) or cefuroxime (500 mg PO BID) or doxycycline (100 mg PO BID; > 8 years old & not pregnant) x 21 days; azithromycin (500 mg PO qday x 14-21 days)

Lyme disease ED Presentations / Management Pearls and Pitfalls

In early infections or indolent infections with arthritis as a preliminary manifestation, oral doxycycline is sufficient. In cases where doxycycline is contraindicated, such as in children under <8 years old and pregnant patients, amoxicillin and cefuroxime axetil are acceptable alternatives. For advanced cases requiring inpatient management, (e.g. neurological or cardiac involvement) intravenous (IV) ceftriaxone is recommended. Duration of therapy depends on degree of disease progression but it usually is for 14-28 days.

Lyme Disease: The Pharmacist’s Role in Treatment and Prevention

Chemoprophylaxis may be considered only in patients who meet all of the following criteria: 1) the tick has been attached for ≥36 hours; 2) the tick is identified as an adult or nymphal I scapularis tick; 3) initiation of prophylaxis with antibiotics is within 72 hours of tick removal; 4) the B burgdorferi infection rate is ≥20% in the local area; and 5) there are no contraindications to doxycycline.

Tick-Borne Illnesses: Identification and Management in the Emergency Department

This issue reviews the emergency department presentation of 9 common tick-borne illnesses and evidence-based recommendations for identification, testing, and treatment.

Could ‘new’ antibiotic treatment prevent chronic Lyme disease?

Lewis estimates that 10% of people treated for acute cases of Lyme go on to develop post-treatment or chronic Lyme. Some advocacy groups for people with tick-borne diseases, such as the Bay Area Lyme Foundation, say persistent Lyme could account for as many as 34% of Lyme cases. Made by a bacterium found in the soil, hygromycin A has been a known antimicrobial since 1953, Lewis says.

Long-Term Antibiotic Use For Lyme Disease Doesn't Work, Study Finds

Lyme disease is a serious illness, caused by bacteria that are transmitted through tick bites. Although the disease has been infecting humans for centuries, it got its name relatively recently, in 1975, when two Yale doctors, Stephen Malawista and Allen Steere, investigated a cluster of illnesses near the town of Lyme, Connecticut.

Persistent Lyme disease symptoms aren’t helped by long-term antibiotics

Doctors sometimes prescribe long courses of antibiotics, but the research on the effectiveness of this practice is patchy. According to the Centers for Disease Control and Prevention, studies have not shown antibiotics to be effective in treating these long-term symptoms.

Potential treatment for Lyme disease kills bacteria that may cause lingering symptoms, study finds

Screening thousands of drugs, Stanford scientists determined that in mice, azlocillin, an antibiotic approved by the Food and Drug Administration, eliminated the bacteria that causes Lyme disease.

The Truth About Treating Lyme Disease

If you have concerns about Lyme disease, it's critical to work with an integrative health provider experienced in this area of treatment. Lyme disease is a complicated condition, but that doesn't mean you are powerless against it.

Trek Tragedy!! Review on Lyme Disease

The drug of choice for Lyme disease is doxycycline; alternatively amoxicillin, azithromycin or ceftriaxone can be used, see figure 5. Please note that azithromycin does not cross the blood brain barrier so ceftriaxone or doxycycline is often preferred, unless contraindicated. Although there is no difference in cure rate between these antibiotics, a single daily dose of doxycycline is likely to be easier to adhere to for patients than more frequent antibiotic regimens. Treatment is continued for at least 21 days.

Unproven Treatments For ‘Chronic Lyme Disease’ Lead To Severe Infections

Patients took prolonged courses of antibiotics for months or even years.

Resources

Emergency Medicine Cases

Clinical Pearl: If a patient suspected of Lyme disease has a 1st degree heart block on ECG, consider admission as many of these patient will go on to develop 3rd degree heart block. Remember that testing for Borelia early in the acute disease state will be negative. Borelia is a slow growing bacterium and does not trigger the IgM/IgG response the assay requires until much later. To prevent disseminated Lyme, treat on spec and assure follow-up testing in 2 weeks.

Emergency Care BC

Early Lyme disease treatment (exposure PLUS erythema migrans) Treatment with appropriate antibiotic for 10-21 days. Doxycycline 100mg PO BID (preferred). Amoxicillin 500mg PO TID. Cefuroxime 500mg PO BID.

Infectious Diseases Society of America

For patients with erythema migrans, we recommend using oral antibiotic therapy with doxycycline, amoxicillin, or cefuroxime axetil (strong recommendation; moderate quality of evidence). Comment: For patients unable to take both doxycycline and beta-lactam antibiotics, the preferred second-line agent is azithromycin.