How long is 'long term' antibiotic treatment ?

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
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Spanky
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Re: How long is 'long term' antibiotic treatment ?

Post by Spanky » Wed 5 Sep 2012 18:05

"Claudia":
To your point, I don't think there is a definitive answer at this time that is possible, especially in disseminated or late-stages of the disease, as it varies case by case (strain(s), co-infections, severity/type of symptoms/damage, immune dysfunction, genetics).
Well, hard to know what to say to that...that hasn't already been said innumerable times, previously.

There is considerable evidence that suggests that the causative organisms are eradicated by short term courses of antibiotics.

That is NOT to say, however, that every single Bb is killed, or that the symptoms that arose during the initial infection will not persist for months or even years or decades.

But treating continuing symptoms as if they are products of ongoing infection simply lacks supportive evidence.

And repeating anonymous, speculative comments to an online blog as if that somehow constitutes...well, anything at all...is just... :bonk:
That's why I have a problem with setting something like that in stone, or having guidelines that are followed without flexibility or question on this issue.

Okay...again...repeating for the (lost track of how many times)...you need to understand that this actually means what it says...regardless of the opinions of some "science writers" or any other "activists":
These guidelines were developed and issued on behalf of the Infectious Diseases Society of America.

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
http://cid.oxfordjournals.org/content/43/9/1089.full

Cobwebby
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Re: How long is 'long term' antibiotic treatment ?

Post by Cobwebby » Wed 5 Sep 2012 19:22

Claudia wrote:
Cobwebby wrote:

And that's what I'm trying to find out- how is it determined when 'long term antibiotic treatment ' is long enough or too long ?
To your point, I don't think there is a definitive answer at this time that is possible, especially in disseminated or late-stages of the disease, as it varies case by case (strain(s), co-infections, severity/type of symptoms/damage, immune dysfunction, genetics). That's why I have a problem with setting something like that in stone, or having guidelines that are followed without flexibility or question on this issue. Evaluating the circumstances of each treatment/failure/or re-treatment result needs to be done carefully, between a patient and their doctor, in order to serve the patient's best interests: case by case. At least in theory. But then you have the waters muddied further by misdiagnosis, and over-treatment possibly motivated by financial incentives, and unrealistic patient expectations.
That's why I have a problem with setting something like that in stone, or having guidelines that are followed without flexibility or question on this issue.
I agree, which is why I asked the question, because the phrase "long term" is so ambiguous and variable in the context of Lyme Disease treatment. I just sort of thought- Hey-what if we're all on the same page ?
It felt like the phrase "long term" was in fact set in stone- and it's not, yet it's thrown out there all the time-either for or against.
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and not on our circumstances.
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Spanky
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Re: How long is 'long term' antibiotic treatment ?

Post by Spanky » Wed 5 Sep 2012 20:19

"Cobwebby":
I agree, which is why I asked the question, because the phrase "long term" is so ambiguous and variable in the context of Lyme Disease treatment.
NO, IT ISN'T.

It is widely understood to mean treatment in excess of the guidelines. Not that difficult.
I just sort of thought- Hey-what if we're all on the same page ?
Endlessly repeating what some of you may have found on that "same page" doesn't improve it.

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Re: How long is 'long term' antibiotic treatment ?

Post by Cobwebby » Thu 6 Sep 2012 14:55

Carina wrote:Cobwebby:
I was treated for two years-is that long term?

Is there any clarification for what constitutes long term?

Is it > 3 months or > 12 months or >24 months or > 3 years?
If you ask a person on IDSA:s side in this controversy, the answer is probably 28 days.
If you ask a person on IDSA:s side in this controversy, the answer is probably 28 days

That's what I thought, too. In that case, it seems that everyone posting on LNE was treated with long term antibiotics.
The greater part of our happiness or misery
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and not on our circumstances.
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Spanky
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Re: How long is 'long term' antibiotic treatment ?

Post by Spanky » Thu 6 Sep 2012 15:12

"Cobwebby":
If you ask a person on IDSA:s side in this controversy, the answer is probably 28 days

That's what I thought, too. In that case, it seems that everyone posting on LNE was treated with long term antibiotics.
As far as I'm concerned, there is only the "side" that is supported by the evidence and reason.

And no, the IDSA Guidelines allow for repeat courses in certain instances beyond 28 days.

Cobwebby
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Re: How long is 'long term' antibiotic treatment ?

Post by Cobwebby » Thu 6 Sep 2012 18:25

Spanky wrote:"Cobwebby":
If you ask a person on IDSA:s side in this controversy, the answer is probably 28 days
That's what I thought, too. In that case, it seems that everyone posting on LNE was treated with long term antibiotics.
As far as I'm concerned, there is only the "side" that is supported by the evidence and reason.
And no, the IDSA Guidelines allow for repeat courses in certain instances beyond 28 days.
Spanky
It is widely understood to mean treatment in excess of the guidelines. Not that difficult.
So you do not consider repeat courses to be in excess of the guidelines?
The greater part of our happiness or misery
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and not on our circumstances.
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Spanky
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Re: How long is 'long term' antibiotic treatment ?

Post by Spanky » Thu 6 Sep 2012 21:42

"Cobwebby":
So you do not consider repeat courses to be in excess of the guidelines?

Ummmm... nooooo...not when the Guidelines specifically allow them. And they do, in certain instances...as I JUST said, above. Repeating:
And no, the IDSA Guidelines allow for repeat courses in certain instances beyond 28 days
What I am saying is that I think that the term "extended" or "longterm" is usually used in Lymeland in contrast to the recommended duration as found in the IDSA Guidelines. The recommended duration in the Guidelines as a minimum...anything in excess of that...you see...

And that would depend on the situation...so there might be situations where repeat courses are allowed.

Now...kind of interesting, as RitaA has noted several times, now, in various threads, Steere is apparently now sometimes going beyond the IDSA Guidelines in cases of treatment resistant Lyme arthritis.

Maybe he's an 'LLMD' now... :lol:

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Re: How long is 'long term' antibiotic treatment ?

Post by duncan » Thu 6 Sep 2012 22:09

Sorry, new to the Forum and the conversation, but if I might toss in a question: So, long term treatment for, say Lyme encephalomyelitis, would be 29 days, but not 27 days, of IV ceftriaxone?

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Spanky
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Re: How long is 'long term' antibiotic treatment ?

Post by Spanky » Thu 6 Sep 2012 23:41

"duncan":
Sorry, new to the Forum and the conversation, but if I might toss in a question: So, long term treatment for, say Lyme encephalomyelitis, would be 29 days, but not 27 days, of IV ceftriaxone?
I am answering based upon my understanding of how the terms have been typically used.

I don't think that anyone means them to imply that type of precise cut-off, rather, the term connotes, say, eight months as opposed to one, or two, if there is a repeat course.

Cobwebby
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Re: How long is 'long term' antibiotic treatment ?

Post by Cobwebby » Fri 7 Sep 2012 5:23

Spanky
But treating continuing symptoms as if they are products of ongoing infection simply lacks supportive evidence.
Then what criteria is used to justify a repeat course of treatment?
The greater part of our happiness or misery
depends on our dispositions,
and not on our circumstances.
Martha Washington

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