Management of Lyme disease focuses on treatment rather than prevention. A vaccine for Lyme disease, which was seemingly safe and effective but also carried a high price tag, was pulled from the market in February 2002 because of low sales and concerns about possible complications.
Infection with Lyme disease is characterized as early or late. Early infection refers to symptoms within 6 months of a bite from an infected tick; late-stage Lyme disease refers to symptoms that have persisted for 6 months or longer. Erythema migrans, the characteristic bull's-eye rash, appears only in the early stage; neurologic involvement may develop at any time. Lyme disease is not contagious and is rarely, if ever, fatal.
The ideal time to treat Lyme disease is in the early phase. Oral dosing with doxycycline or amoxicillin is the treatment of choice for most patients. The optimal duration of treatment for early disease remains controversial. The Infectious Diseases Society of America (IDSA) in 2000 recommended initial treatment with oral antibiotics for 14-21 days, but some experts now suggest treatment for 10-14 days is adequate. They cite study results showing that a 10-day course of doxycycline was as effective as treatment for 20 days.
For patients who realize they've been bitten by a tick that has been attached and feeding for some time (more than 48 hours), a single 200-mg dose of doxycycline taken with food has been shown to be 87% effective in preventing Lyme disease. However, since only one-third of Lyme disease patients recall a tick bite, the absence of a bite in a patient's history does not rule out Lyme disease. Guidelines on treating Lyme disease from the IDSA were published in 2000 (Clin. Infect. Dis. 31[suppl. 1]:S1-14, 2000).
--Mitchel L. Zoler, Editor
--Heidi Splete, Writer
COPYRIGHT 2004 International Medical News Group
COPYRIGHT 2004 Gale Group