Point/Counterpoint (Auwaerter and Stricker) 2007

Medical topics with questions, information and discussion related to Lyme disease and other tick-borne diseases.
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cavey
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Joined: Sun 21 Dec 2008 16:53

Point/Counterpoint (Auwaerter and Stricker) 2007

Post by cavey » Fri 26 Dec 2008 15:57

Clin Infect Dis. 2007 Jul 15;45(2):143-8. Epub 2007 Jun 5.Click here to read Links

Comment in:
Clin Infect Dis. 2007 Jul 15;45(2):149-57.

Point: antibiotic therapy is not the answer for patients with persisting symptoms attributable to lyme disease.
Auwaerter PG.

Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA. pauwaert@jhmi.edu

It is not well understood why some patients develop a subjective syndrome that includes considerable fatigue, musculoskeletal aches, and neurocognitive dysfunction after receiving standard antibiotic courses for the treatment of Lyme disease. Some practitioners use the term "chronic Lyme disease" and order prolonged courses of oral and parenteral antibiotics, believing that persistent infection with Borrelia burgdorferi is responsible. However, well-performed prospective studies have found neither evidence of chronic infection nor a benefit worthy of long-term antibiotic therapy for these patients. Such extended antibiotic therapy poses hazards and cannot be viewed as acceptable. The term "chronic Lyme disease" should be discarded as misleading; rather, the term "post-Lyme disease syndrome" better reflects the postinfectious nature of this condition. Further research is necessary to understand possible mechanisms of these chronic symptoms following Lyme disease as well as to find effective therapies.

PMID: 17578771 [PubMed - indexed for MEDLINE]

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Counterpoint: long-term antibiotic therapy improves persistent symptoms associated with lyme disease.
Stricker RB.
International Lyme and Associated Diseases Society, Bethesda, MD, USA. rstricker@usmamed.com

BACKGROUND:

Controversy exists regarding the diagnosis and treatment of Lyme disease. Patients with persistent symptoms after standard (2-4-week) antibiotic therapy for this tickborne illness have been denied further antibiotic treatment as a result of the perception that long-term infection with the Lyme spirochete, Borrelia burgdorferi, and associated tickborne pathogens is rare or nonexistent.

METHODS:

I review the pathophysiology of B. burgdorferi infection and the peer-reviewed literature on diagnostic Lyme
disease testing, standard treatment results, and coinfection with tickborne agents, such as Babesia, Anaplasma, Ehrlichia, and Bartonella species. I also examine uncontrolled and controlled trials of prolonged antibiotic therapy in patients with persistent symptoms of Lyme disease.

RESULTS: The complex "stealth" pathology of B. burgdorferi allows the spirochete to invade diverse tissues,
elude the immune response, and establish long-term infection. Commercial testing for Lyme disease is highly specific but relatively insensitive, especially during the later stages of disease. Numerous studies have documented the failure of standard antibiotic therapy in patients with Lyme disease. Previous uncontrolled trials and recent placebo-controlled trials suggest that prolonged antibiotic therapy (duration, >4 weeks) may be beneficial for patients with persistent Lyme disease symptoms. Tickborne coinfections may increase the severity and duration of infection with B. burgdorferi.

CONCLUSIONS: Prolonged antibiotic therapy may be useful and justifiable in patients with persistent symptoms of Lyme disease and coinfection with tickborne agents.

PMID: 17578772 [PubMed - indexed for MEDLINE

Fin24
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Re: Point/Counterpoint (Auwaerter and Stricker) 2007

Post by Fin24 » Fri 26 Dec 2008 19:32

philosophy one
well-performed prospective studies have found neither evidence of chronic infection nor a benefit worthy of long-term antibiotic therapy for these patients
which then informs the usual/customary "standard of care"

philosophy two
establish long-term infection
Previous uncontrolled trials and recent placebo-controlled trials suggest that prolonged antibiotic therapy (duration, >4 weeks) may be beneficial for patients with persistent Lyme disease symptoms
which influences adifferent usual/treatment handling "std of care"

HOW can anyone think there are only ONE so called standard as in one philosophy of tx??

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LymeEnigma
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Re: Point/Counterpoint (Auwaerter and Stricker) 2007

Post by LymeEnigma » Sat 27 Dec 2008 23:36

cavey wrote:CONCLUSIONS: Prolonged antibiotic therapy may be useful and justifiable in patients with persistent symptoms of Lyme disease and coinfection with tickborne agents.
The emphasis is on the MAY. If long-term therapy was an actual treatment standard, then the "may" would be an "is."

Fin24
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Joined: Sat 8 Mar 2008 20:14

Re: Point/Counterpoint (Auwaerter and Stricker) 2007

Post by Fin24 » Sun 28 Dec 2008 1:59

sorry I vehemently DISAGREE

take cancer my sis just dx with renal stage 4--she is undergoing a "standard of care" as defined by her dr and her insurance company and yet the literature says her protocol MAY extend her life and MAY stop further mets ( cant spell that--metasthetis...whatever)

you CAN use the word "MAY" as long as the tyx is acceptable to a group in the field and based upon some jointly accepteable evidence--sometimes all you need is "probable" which is more than "possible" and you dont always need the "is"

I rarely if EVER have seen the need for absolute proof something DOES something else to be a std of care or even SOP in the labs ( std operating procedure) again sometimes science works on a probability--a 'more likely', a 'slightly better than' --look at drug approvals--they become "std" and yet where is their proof--even often the wording sint " WILL imporve cholesterol" its "MAY improve your stroke risk"

heck even strep-there is NO guarantee that penicillin will abate it--the studies show it is LIKELY in a percentage of pts hence acceptable to Rx and its the std of care for strep throat--I doubt any dr would be questioned for Rxing that ( unless allergy etc)

its usually a scenario of "more likely than not" same with risks of ts--they can never guarantee no risks

so the risks usually must be at some lower threshhold than the benefits!!

the "may" leaves the door open that was shut by IDSA saying " nothing past 30 days, No IV unless limiting criteria are met etc"...and the "may" implies the need for more studies---which is true

I dont thisk that wording had anything to do whether their protocol will or wont be accepted as a std of care

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