How to treat Post-Lyme disease syndromes

1. How to treat Post-Lyme disease syndromes Antibiotics are the primary treatment for Lyme disease, and nearly all patients recover after being treated with antibiotics. The recommended treatment for Lyme disease varies depending on the stage of the illness and the symptom types. The recovery rate may also vary depending on the specific symptoms, and recovery may take weeks to months after antibiotic treatment is complete. Substances released by the dying bacteria cause a brief worsening of symptoms in about 10 to 15 per cent of people with early Lyme disease. This reaction takes place within 24 hours of starting antibiotics, continues for about a day and then resolves. Where this reaction develops, antibiotic therapy should not be stopped but should instead continue as originally planned. There is no evidence that any of the antibiotics commonly used for treating the infection are resistant to the Lyme bacteria. In rare cases, additional therapy may be used for short periods of time (typically one month) beyond the recommended dosages. There is no evidence, however, that additional treatment with any antibiotics results in improvement of symptoms that slowly resolve. Early Localized Lyme disease— Early Localized Lyme disease is treated with oral antibiotics, usually doxycycline, amoxicillin, or cefuroxime, taken daily. Doxycycline is administered for 10-21 days, and amoxicillin and cefuroxime for 14-21 days. Early spread of Lyme disease— the recommended treatments may be either oral or intravenous antibiotics when Lyme disease is recognized after it has moved from the tick bite site to other places. Oral antibiotics are used in cases deemed to be less serious. These include cases of multiple skin lesions, nerve involvement (such as facial palsy) in which the symptoms are limited to nerves not involving the

2. brain or spinal cord, and mild cases of heart inflammation (typically causing slight delays in conducting electrical signals from one part of the heart to another). A spinal tap may be required to test the cerebrospinal fluid (CSF) for evidence of infection in cases of nerve involvement, such as facial palsy, before deciding whether to treat with oral or intravenous antibiotics. More serious manifestations are usually treated with intravenous therapy, including meningitis (inflammation of the lining of the brain and spinal cord) and more advanced forms of heart block with moderate to severe delays in conduction. The entire course of antibiotics is often intravenously administered for meningitis. For heart block, patients are generally given initially and monitored in the hospital with intravenous antibiotics; in addition, patients with complete heart block may require a temporary pacemaker, resulting in a very slow heartbeat. The patients are often changed to oral antibiotics when the heart block has improved. For patients with multiple symptoms the most serious manifestation dictates the treatment used. Intravenous antibiotic treatment is typically recommended for 10 to 28 days. Intravenous (IV) therapy is normally initiated in the office or emergency department of a health care provider. It can be continued at home, and monitored by a health nurse visiting or at home. Patients receiving intravenous therapy at home should observe symptoms of IV-line infection or inflammation, redness and swelling, and symptoms of blood clotting in the vein and swelling of the arm or armpit. Because of the risks associated with intravenous antibiotics, in some Lyme disease patients where the risk of intravenous therapy is increased, some clinicians may choose to use oral antibiotics even for more serious disease manifestations.

3. The use of intravenous antibiotics has not been proved to result in faster or more complete improvement of symptoms, even in severe cases of meningitis and heart blockage. In many cases of Lyme disease, oral antibiotics appear to be equivalent to intravenous antibiotics related to meningitis, and increasing numbers of US providers are starting to use oral doxycycline to treat meningitis. Late Lyme disease — Late Lyme disease manifestations include arthritis, and neurological conditions. Late Lyme disease arthritis resolves with oral antibiotic therapy given for 28 days in most individuals; intravenous antibiotics are recommended only if the arthritis does not improve with oral therapy. However, after antibiotic therapy arthritis persists in some adults and children. Arthritis that persists after antibiotic therapy may require therapies for other types of arthritis and/or synovectomy (the joint lining is surgically removed). More information is discussed separately about those treatments. (See "Patient education: treatment for osteoarthritis. Late Lyme disease related neurological conditions are treated with intravenous antibiotics, usually ceftriaxone or cefotaxime, given daily for two to four weeks. Syndromes of post-Lyme disease— In some people, symptoms such as headache, fatigue, and joint pain do not resolve immediately after completion of treatment. Additionally, after a gap of several weeks to months after antibiotic treatment for Lyme disease, some patients develop pain or fatigue. Those symptoms usually resolve over time gradually. Taking more antibiotics doesn't improve the symptoms or shorten the course of symptoms after Lyme. All the samples were analyzed using Lyme immunoblot tests recently developed by IGeneX LabUSA and relapsing fever borne by ticks. These tests use genetically engineered Borrelia proteins to look for antibodies to some 15 different Borrelia species which may be present in the blood of patients. Dr Its said that the large number of species targeted in the immunoblot test contrasts with the usual one or two species detected using older technology in tests. The results of the study are consistent with earlier findings in which using IGenex immunoblot tests western blot test, she said, a relatively high number of tested positive for antibodies to these tick-borne diseases. But the results didn't necessarily mean the patients in USA had been infected with tick-borne relapsing fever Borrelia, though that was quite possible.