Studies on late uncomplicated Lyme

General or non-medical topics with information and discussion related to Lyme disease and other tick-borne diseases.
X-member
Posts: 9899
Joined: Mon 30 Jul 2007 18:18

Studies on late uncomplicated Lyme

Post by X-member » Sun 25 Dec 2011 0:22

As you have seen, there is a topic about late complicated Lyme (= what most of the cases with late/chronic and more difficult to treat Lyme suffer from), and in that topic I think that it will not be posted soo many studies or research. So let us start with uncomplicated late Lyme instead, and see what we can find about this.

X-member
Posts: 9899
Joined: Mon 30 Jul 2007 18:18

Re: Studies on late uncomplicated Lyme

Post by X-member » Sun 25 Dec 2011 0:37

This is a study on European uncomplicated early and late/chronic Lyme (yes, I have posted it in many places in this forum now ;) ):

http://www.ncbi.nlm.nih.gov/pubmed/3056202

Antibiotic therapy of early European Lyme borreliosis and acrodermatitis chronica atrophicans.
Weber K, Preac-Mursic V, Neubert U, Thurmayr R, Herzer P, Wilske B, Schierz G, Marget W.

Department of Microbiology, University of Munich, Federal Republic of Germany.

Abstract

In a study on 121 consecutive patients with erythema migrans, 65 patients obtained oral penicillin, 36 tetracyclines, and 20 amoxicillin-clavulanic-acid. Follow-up was carried out for a median of 29, 17, and 7 months, respectively. In another limited trial on 29 patients with acrodermatitis chronica atrophicans (ACA), 14 patients received oral penicillin, 9 parenteral penicillin, and 6 tetracyclines. There was no statistically significant difference among treatment groups in both therapeutic trials, with the exception of different follow-ups due to the nonrandomized study design and different occurrence of the Jarisch-Herxheimer reaction in patients with erythema migrans. Later extracutaneous manifestations developed in 27% of the patients with erythema migrans and in 47% of the patients with ACA despite antibiotic therapy. We could not prove the superiority of any antibiotic tested in either early or late European Lyme borreliosis.
The answer (about late Lyme) in this study is that they don't know how to treat it. Some of the patients are cured, and some are not. And they DON'T TALK ABOUT any Post Lyme Disease Syndrome, at all!

This study is used in the Swedish recommendations! But if you are not cured, you get answers (from physicians) based on studies made on early Neuroborreliosis (=could give remaining symtoms), or answers from studies made on cases who suffer from PLDS (you know those studies by now, don't you? :roll: ).

But in the Swedish recommendations, they only say, that "more ABX don't work on remaining symptoms" (after a cured infection).

So, you can not trust any person that don't read what they actually say (in the recommendation).

X-member
Posts: 9899
Joined: Mon 30 Jul 2007 18:18

Re: Studies on late uncomplicated Lyme

Post by X-member » Sun 25 Dec 2011 2:43

They say that Swedish people often are rude! And this could be, because we go straight on to the problem, and also because we maybe don't know or understand how rude we actually are! ;)

Now I have apologized for that! I hope! :D

But, "some" in this forum have actually given me/us the wrong info soo many times, so you must understand my reactions!

What was my point with this, you wonder?

The point is, that when I asked our Swedish "IDSA" (Läkemedelsverket/The MPA), they gave me the correct info (=studies on late/chronic B Afzelii Lyme) right away! I didn't have to explain and explain and talk about totally different things for a while, and then explain again (as in some "endless" discussions in this forum).

The Swedish MPA gave me the right info without being "difficult" in any way!

Is this how Swedish people are? Or are the Swedish MPA more honest than other instances, in other parts of the world?

And IF IDSA actaully say (I still don't think soo) that chronic Lyme (=stage 3 Lyme) don't exist, why don't you ask them about studies on late Lyme (=stage 3 Lyme) instead?

But maybe they don't answer you, you say? Have you tried?

Camp Other
Posts: 996
Joined: Wed 2 Mar 2011 4:32
Contact:

Re: Studies on late uncomplicated Lyme

Post by Camp Other » Sun 25 Dec 2011 7:41

Carina said,
"And IF IDSA actually say (I still don't think soo) that chronic Lyme (=stage 3 Lyme) don't exist, why don't you ask them about studies on late Lyme (=stage 3 Lyme) instead?"
I've tried to make this clear before, and will try again:

IDSA thinks Stage 3 Lyme disease is late stage Lyme disease. They do NOT use the term chronic to describe this stage.

IDSA thinks that any symptoms which persist AFTER antibiotic treatment for Lyme disease are considered up to 6 months after antibiotic treatment to be Post-Lyme Disease symptoms, and when it's longer than 6 months, Post-Lyme Disease Syndrome.

Patients have asked about late stage (stage 3) studies and the need for more, as have doctors (google Dr. Elizabeth Maloney).

It's just that many patients have also asked about why there aren't more studies for patients who have been treated with antibiotics using the IDSA's standard of care (3-4 weeks of oral doxycycline, and perhaps a month of ceftriaxone, max if someone has neuroborreliosis) yet CONTINUE to have symptoms.

From my observation, most of the Lyme disease patients on support groups in the US (Lymenet, Lymefriends, others) have had more than the IDSA recommended antibiotic treatment for Lyme disease and continue to have symptoms.

X-member
Posts: 9899
Joined: Mon 30 Jul 2007 18:18

Re: Studies on late uncomplicated Lyme

Post by X-member » Sun 25 Dec 2011 17:02

Yes, I understand the problem, but I try to understand what on earth this have to do with people that suffer from the European definition of chronic Lyme (late Lyme)!

I get angry when an European physician actually say to me that late Lyme don't exist (due to the "mess" in US). There are studies on this (as you can see), so it do exist.

When it comes to European late Lyme, I am mainly interested in B Afzelli, because many people don't know so much about it!

And (of course) because the majority of the cases with late (or chronic) Lyme in Sweden suffer from a B Afzelii-infection!

X-member
Posts: 9899
Joined: Mon 30 Jul 2007 18:18

Re: Studies on late uncomplicated Lyme

Post by X-member » Thu 1 Mar 2012 21:33

Here are some of the studies that they use when they talk about late Lyme disease:

1: Logigian EL et al, Chronic neurologic manifestations of Lyme disease, N. Engl. J. Med. (1990),
323: 1438-1444

2: Ziska MH et al, Physician Preferences in the Diagnosis and Treatment of Lyme Disease in the
United States, Infection (1996) 24 No. 2, MMV Medizin Verlag GmbH, München, 1996

3: Asch ES et al, Lyme Disease: Ann. Infectious and Postinfectious Syndrome, J. Rheumatol.
(1994), 21: 454-456

4: Hassler D, Langzeitbeobachtungen zum Krankheitsbild der Lyme-Borreliose in einem
Endemiegebiet, Habilitationsschrift Universität Erlangen (1997)

5: Dattwyler RJ et al, Treatment of late Lyme disease, Lancet (1988), 1: 1191-4

6: Dattwyler RJ et al, Treatment of late Lyme disease – a comparison of 2 weeks vs 4 weeks of
ceftriaxone, VII International Congress of Lyme Borreliosis, San Francisco (1996), abstract
D662

7: Steere AC et al, The spirochetal etiology of Lyme disease, N Engl J Med (1983), 308:733-40

8: Steere AC et al, Treatment of Lyme Arthritis, Arthritis & Rheumatism (1994), 37: 878-888

Edit to add:

I forgot! The studies above, are the same studies mentioned in the topic below:

http://www.lymeneteurope.org/forum/view ... 555#p26668

A quote:
There is a high therapeutic failure rate for the antibiotic treatment of
lyme borreliosios in its late phase (52, 54-56, 65, 75-77)
And one study on late European Lyme disease you find earlier in this topic!

X-member
Posts: 9899
Joined: Mon 30 Jul 2007 18:18

Re: Studies on late uncomplicated Lyme

Post by X-member » Thu 1 Mar 2012 23:35

I didn't find the full text to this:
5: Dattwyler RJ et al, Treatment of late Lyme disease, Lancet (1988), 1: 1191-4
But I found the references, and maybe we can find more studies on late Lyme disease/chronic borreliosis here?:

http://www.thelancet.com/journals/lance ... 5/fulltext
1 Weber K.. Therapy of cutaneous manifestations. In: . Berlin: Springer, 1993: 312-327.

2 Preac-Mursic V.. Antibiotic susceptibility of Borrelia burgdorferi in vitro and in vivo. In: . Berlin: Springer, 1993: 301-311.

3 Weber K., Wilske B., Preac-Mursic V., Thurmayr R.. Azithromycin versus penicillin V for the treatment of early Lyme borreliosis. Infection 1993; 21: 361-372. PubMed

4 Steere Ac, Hutchinson Gj, Rahn Dw, et al. Treatment of the early manifestations of Lyme disease. Ann Intern Med 1983; 99: 22-26. Weber K., Preac-Mursic V., Wilske B., Thurmayr R., Neubert U., Scherwitz C.. A randomized trial of ceftriaxone versus oral penicillin for the treatment of early European Lyme borreliosis. Infection 1990; 18: 91-96. CrossRef | PubMed

6 Strle F., Ruzic E., Cimperman J.. Erythema migrans: comparison of treatment with azithromycin, doxycycline and phenoxymethylpenicillin. J Antimicrob Chemother 1992; 30: 543-550. PubMed

7 Dattwyler Rj, Volkman Dj, Conaty Sm, Platkin Sp, Luft BJ.. Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet 1990; ii: 1404-1406. PubMed

8 Massarotti Em, Luger Sw, Rahn Dw, et al. Treatment of early Lyme disease. Am J Med 1992; 92: 396-403. CrossRef | PubMed

9 Nadelman Rb, Luger Sw, Frank E., Wisniewski M., Collons Jj, Wormser GP.. Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease. Ann Intern Med 1992; 117: 273-280. PubMed

10 Luft Bj, Luger Sw, Rahn Dw, Dattwyler Rj, Gadgil SD.. Azithromycin and amoxycillin for the treatment of erythema migrans. Preliminary analysis of a double-blind trial. In: Abstracts of the Fifth International Conference on Lyme borreliosis, Arlington, VA . 1992.

11 Weber K., Neubert U., Thurmayr R.. Antibiotic therapy in early erythema migrans disease and related disorders. Zentralbl Bakteriol Hyg (A) 1986; 263: 377-388. PubMed

12 Weber K., Preac-Mursic V., Neubert U., et al. Antibiotic therapy of early European Lyme borreliosis and acrodermatitis chronica atrophicans. Ann NY Acad Sci 1988; 539: 324-345. PubMed

13 Weber K., Thurmayr R.. Oral penicillin versus minocycline for the treatment of early Lyme borreliosis. Zentralbl Bakteriol 1989; 18: 263-268. (suppl) PubMed

14 Pfister Hw, Kristoferitsch W., Sköldenberg B.. Therapy of Lyme neuroborreliosis. In: . Berlin: Springer, 1993: 328-339.

15 Kristoferitsch W., Baumhackl U., Sluga E., Stanek G., Zeiler K.. High-dose penicillin therapy in meningopolyneuritis Garin-Bujadoux- Bannwarth. Zentralbl Bakteriol Hyg (A) 1986; 263: 357-364. PubMed

16 Steere Ac, Pachner Ar, Malawista SE.. Neurologic abnormalities of Lyme disease: successful treatment with high-dose intravenous penicillin. Ann Intern Med 1983; 99: 767-772. PubMed

17 Pfister Hw, Einhäupl Km, Franz P., Garner C.. Corticosteroids for radicular pain in Bannwarth's syndrome. A double-blind, randomized, placebo-controlled trial. Ann NY Acad Sci 1988; 539: 485-487. PubMed

18 Pfister Hw, Preac-Mursic V., Einhäupl Km, Wilske B.. Cefotaxime versus penicillin G for acute neurological manifestations of Lyme borreliosis: a prospective randomized study. Arch Neurol 1989; 46: 1190-1194. PubMed

19 Pfister Hw, Preac-Mursic V., Wilske B., Schielke E., Soergel F., Einhäupl KM.. Randomized comparison of ceftriaxone and cefotaxime in Lyme neuroborreliosis. J Infect Dis 1991; 163: 311-318. CrossRef | PubMed

20 Kohlhepp W., Oschmann P., Mertens HG.. Treatment of Lyme borreliosis. Randomized comparison of doxycycline and penicillin G. J Neurol 1989; 236: 464-469. CrossRef | PubMed

21 Müllegger Rr, Millner Mm, Stanek G., Spork KD.. Penicillin G sodium and ceftriaxone in the treatment of neuroborreliosis in children—a prospective study. Infection 1991; 19: 279-283. CrossRef | PubMed

22 Mayer-Berger W., van der Linde Mr, Hassler D.. Therapy of Lyme carditis. In: . Berlin: Springer, 1993: 344-349.

23 Schonherr U., Strle F.. Ocular manifestations. In: . Berlin: Springer, 1993: 248-258.

24 Steere Ac, Green J., Schoen Rt, et al. Successful parenteral penicillin therapy of established Lyme arthritis. N Engl J Med 1985; 312: 869-874. CrossRef | PubMed

25 Dattwyler Rj, Volkman Dj, Halperin Jj, Luft BJ.. Treatment of late Lyme borreliosis-randomised comparison of ceftriaxone and penicillin. Lancet 1988; i: 1191-1194. PubMed

26 Hassler D., Zöller L., Haude M., Hufnagel Hd, Heinrich F., Sonntag HG.. Cefotaxime versus penicillin in the late stage of Lyme disease— prospective, randomized therapeutic study. Infection 1990; 18: 16-20. CrossRef | PubMed

27 Liu Ny, Dinerman H., Levin Re, et al. Randomized trial of doxycycline vs amoxicillin/probenecid for the treatment of Lyme arthritis: treatment of non-responders with IV penicillin or ceftriaxone (abstract). Arthritis Rheum 1989; 32: 46. (suppl) PubMed

28 Herzer P.. Therapy of joint manifestations. In: . Berlin: Springer, 1993: 340-343.

29 Steere Ac, Dwyer E., Winchester R.. Association of chronic Lyme arthritis with HLA-DR 4 and HLA-DR2 alleles. N Engl J Med 1990; 323: 219-223. CrossRef | PubMed

30 Schoen Rt, Aversa Jm, Rahn Dw, Steere AC.. Treatment of refractory chronic Lyme arthritis with arthroscopic synovectomy. Arthritis Rheum 1991; 34: 1056-1060. CrossRef | PubMed

31 Logigian El, Kaplan Rf, Steere AC.. Chronic neurologic manifestations of Lyme disease. N Engl J Med 1990; 323: 1438-1444. CrossRef | PubMed

32 Weber K.. Jarisch-Herxheimer-Reaktion bei Erythema-migrans- Krankheit. Hautarzt 1984; 35: 588-590. PubMed

33 Preac-Mursic V., Weber K., Pfister Hw, et al. Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis. Infection 1989; 17: 355-359. CrossRef | PubMed

34 Dinerman H., Steere AC.. Lyme disease associated with fibromyalgia. Ann Intern Med 1992; 117: 281-285. PubMed

35 Jaenson Tgt, Fish D., Ginsberg Hs, Gray Js, Mather Tn, Piesman J.. Methods for control of tick vectors of Lyme borreliosis. Scand J Infect Dis 1991; 77: 151-157. (suppl) PubMed

36 Burgdorfer W., Anderson Jf, Gern L., Lane Rs, Piesman J., Spielman A.. Relationship of Borrelia burgdorferi to its arthropod vectors. Scand J Infect Dis 1991; 77: 35-40. (suppl) PubMed

37 Paul H., Gerth Hj, Ackermann R.. Infectiousness for humans of Ixodes ricinus containing Borrelia burgdorferi.. Zentralbl Bakteriol Hyg (A) 1986; 263: 473-476. PubMed

38 Shapiro Ed, Gerber Ma, Holabird Nb, et al. A controlled trial of antimicrobial prophylaxis for Lyme disease after deer-tick bites. N Engl J Med 1992; 327: 1769-1773. CrossRef | PubMed

39 Magid D., Schwartz B., Craft J., Schwartz JS.. Prevention of Lyme disease after tick bites. A cost-effectiveness analysis. N Engl J Med 1992; 327: 534-541. CrossRef | PubMed

40 Hassler D., Riedel K., Zorn J., Preac-Mursic V.. Pulsed high-dose cefotaxime therapy in refractory Lyme borreliosis. Lancet 1991; ii: 193. PubMed

X-member
Posts: 9899
Joined: Mon 30 Jul 2007 18:18

Re: Studies on late uncomplicated Lyme

Post by X-member » Mon 8 Apr 2013 15:07

http://www.praxis-berghoff.de/dokumente ... glisch.pdf

From the link above:
"There is a high therapeutic failure rate for the antibiotic treatment of lyme borreliosios in its late phase (52, 54-56, 65, 75-77)"
http://www.efns.org/fileadmin/user_uplo ... liosis.pdf

From the link above:
"There are NO comparative controlled studies of treatment length in European late LNB"

X-member
Posts: 9899
Joined: Mon 30 Jul 2007 18:18

Re: Studies on late uncomplicated Lyme

Post by X-member » Mon 8 Apr 2013 15:11

http://www.borreliose-gesellschaft.de/T ... elines.pdf

From the link above:
In the early stage, i. e. in the first 4 weeks after the start of infection, a failure rate of 10% is to be expected with antibiotic treatment (121/135)
In the chronic forms, it is significantly higher at up to 50%. (30/31/52/55/74/99/121)

Even earlier studies referred to the problem area of chronic Lyme borreliosis and the limits of its susceptibility to treatment (31/55/59/61/62/65/92/94/121/138)

In all these studies, the duration of treatment was generally limited to a maximum of four weeks. Considerable therapeutic failure rates occurred under these conditions, even with repeated courses of treatment. (78/82/90)
The duration of treatment is of decisive importance for the success of antibiotic treatment.

There are now a few studies available which provide evidence of the positive effect and the safety of long-term antibiotic therapy.(25/26/27/30/36/44/46/51/52/81/144)

The limited effect of antibiotic treatment is documented in numerous studies: Pathogens were cultured even after supposedly highly effective antibiotic therapy.(63/74/81/96/119/120/122/139/147)
One more quote:
"The term “chronic Lyme borreliosis” is equivalent to Stage III."

Camp Other
Posts: 996
Joined: Wed 2 Mar 2011 4:32
Contact:

Re: Studies on late uncomplicated Lyme

Post by Camp Other » Mon 8 Apr 2013 20:18

Carina wrote:I didn't find the full text to this:
5: Dattwyler RJ et al, Treatment of late Lyme disease, Lancet (1988), 1: 1191-4
Try this: http://www.unboundmedicine.com/5minute/ ... penicillin_

Treatment of late Lyme borreliosis--randomised comparison of ceftriaxone and penicillin.

Authors
Dattwyler RJ, Halperin JJ, Volkman DJ, et al.

Institution
Department of Internal Medicine, School of Medicine, State University of New York, Stony Brook.

Source
Lancet 1988 May 28; 1(8596) :1191-4.

Abstract
23 patients with clinically active late Lyme disease were randomly assigned to intravenous treatment with either penicillin or ceftriaxone. Of the 10 treated with penicillin, 5 were judged treatment failures; of the 13 who received ceftriaxone, only 1 did not respond. An additional 31 patients were subsequently treated with ceftriaxone 4 g/day (n = 17) or 2 g/day (n = 14); success rates in both groups were comparable to those in the cohort randomised to ceftriaxone. Patients unresponsive to ceftriaxone were more likely to have received corticosteroid treatment.

(I'm still looking for full text myself, but perhaps the above is useful in meantime.)

Post Reply