TREATMENT OF LYME DISEASE: EARLY, LATE AND CHRONIC LYME DISEASE

Early Lyme Disease with Acute Neurologic Involvement
Acute neurologic involvement includes aseptic meningitis or radiculopathy. Parenteral therapy with ceftriaxone, penicillin G, or cefotaxime is recommended for both children and adults. Oral or parenteral doxycycline can be used for patients over 8 years of age with intolerance of penicillins or cephalosporins.
Lumbar puncture may be reserved for patients with severe headache, nuchal rigidity, or other signs and symptoms of central nervous system involvement. If cerebrospinal fluid study findings are normal, an oral regimen is preferred. In cases of cranial nerve palsy, an oral regimen may be used to prevent further sequelae.
Late Disease
Arthritis without neurologic disease can be treated with a 28-day course of oral amoxicillin or doxycycline. However, some patients go on to develop signs of neuroborreliosis after treatment with an oral regimen, necessitating parenteral antibiotics anyway. Treatment of arthritis with neurologic involvement is the same as treatment of early Lyme disease with central nervous system involvement and includes parenteral ceftriaxone, penicillin G, or cefotaxime.
Recurrent or persistent arthritis can be treated with oral or parenteral therapy. It is important to wait for months between courses of treatment given the slow resolution of inflammation. If arthritis persists or recurs after two courses of oral therapy or one course of parenteral therapy, symptomatic treatment with non-steroidal anti-inflammatory drugs may be effective. No further antibiotic therapy is recommended.
Chronic Lyme Disease
Despite appropriate treatment, some patients experience persistent fatigue, myalgias, arthralgias, neurocognitive dysfunction, and other subjective symptoms similar to those reported in cases of fibromyalgia or chronic fatigue syndrome. There is still debate over whether chronic Lyme disease represents a separate disease entity. Some experts believe that Lyme disease may trigger the onset of fibromyalgia. In a study by Kalish et al, chronic subjective symptoms were reported to occur more commonly in patients who presented with early dissemination to the nervous system, especially if antibiotic therapy was delayed. In contrast, a recent longitudinal cohort study reports that symptoms consistent with chronic Lyme disease were just as common in age-matched, uninfected control subjects. Prolonged or repeated courses of antibiotics have no demonstrated efficacy in these patients and should be avoided.
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TREATMENT OF LYME DISEASE: EARLY, LATE AND CHRONIC LYME DISEASEEarly Lyme Disease with Acute Neurologic InvolvementAcute neurologic involvement includes aseptic meningitis or radiculopathy. Parenteral therapy with ceftriaxone, penicillin G, or cefotaxime is recommended for both children and adults. Oral or parenteral doxycycline can be used for patients over 8 years of age with intolerance of penicillins or cephalosporins.Lumbar puncture may be reserved for patients with severe headache, nuchal rigidity, or other signs and symptoms of central nervous system involvement. If cerebrospinal fluid study findings are normal, an oral regimen is preferred. In cases of cranial nerve palsy, an oral regimen may be used to prevent further sequelae.

Late DiseaseArthritis without neurologic disease can be treated with a 28-day course of oral amoxicillin or doxycycline. However, some patients go on to develop signs of neuroborreliosis after treatment with an oral regimen, necessitating parenteral antibiotics anyway. Treatment of arthritis with neurologic involvement is the same as treatment of early Lyme disease with central nervous system involvement and includes parenteral ceftriaxone, penicillin G, or cefotaxime.Recurrent or persistent arthritis can be treated with oral or parenteral therapy. It is important to wait for months between courses of treatment given the slow resolution of inflammation. If arthritis persists or recurs after two courses of oral therapy or one course of parenteral therapy, symptomatic treatment with non-steroidal anti-inflammatory drugs may be effective. No further antibiotic therapy is recommended.
Chronic Lyme DiseaseDespite appropriate treatment, some patients experience persistent fatigue, myalgias, arthralgias, neurocognitive dysfunction, and other subjective symptoms similar to those reported in cases of fibromyalgia or chronic fatigue syndrome. There is still debate over whether chronic Lyme disease represents a separate disease entity. Some experts believe that Lyme disease may trigger the onset of fibromyalgia. In a study by Kalish et al, chronic subjective symptoms were reported to occur more commonly in patients who presented with early dissemination to the nervous system, especially if antibiotic therapy was delayed. In contrast, a recent longitudinal cohort study reports that symptoms consistent with chronic Lyme disease were just as common in age-matched, uninfected control subjects. Prolonged or repeated courses of antibiotics have no demonstrated efficacy in these patients and should be avoided.*165/348/5*

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