NEW YORK (Reuters Health) - After considering the clinical evidence, members of the National Academy of Neurology conclude that “there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post-Lyme syndrome.”
There already are guidelines for the diagnosis and general treatment of infections caused by Borrelia burgdorferi, which is transmitted by a tick bite, Dr. John J. Halperin and other members of the Quality Standards Subcommittee point out in the advance online edition of the medical journal Neurology. However, there is no consensus regarding treatment of B. burgdorferi infection of the central nervous system, which includes the brain and spinal tissue.
To address this controversy, Halperin, at Overlook Hospital, in Summit, New Jersey, and the subcommittee analyzed data from clinical trials published between 1983 and 2003.
They found few studies addressing the rare situation in which areas of the CNS responsible for actual functioning were involved, so their review was limited primarily to infection causing meningitis (inflammation of the lining of the brain), cranial neuritis (inflammation of the nerves in the brain or spine), as well as post-Lyme syndrome.
The authors identified 37 articles that contributed “relevant, assessable data” regarding treatment of neurological B. burgdorferi infection from peer-reviewed articles. They propose three recommendations:
— Injection or infusion with penicillin, ceftriaxone, and cefotaxime is “probably safe and effective” for treating Lyme disease associated with the nervous system.
— Oral treatment with the antibiotic doxycycline is also likely to be effective, as long as functional areas of the CNS are not involved.
— Post-Lyme syndrome - the chronic symptoms following successful treatment with antibiotics — is not cause by active infection, the evidence suggests, and does not respond to continued antibiotic therapy. Therefore, the subcommittee does not recommend prolonged courses of antibiotics, given the drugs’ potential side effects.
There is less information regarding the treatment of children and no evidence to definitively establish whether the best way to administer antibiotics is orally, intravenously or by injection. However, the subcommittee notes that “all available data indicate the results are comparable to those observed in adults.”
According to a press statement from the American Academy of Neurology, this addition to the guidelines is endorsed by the Infectious Diseases Society of America.
SOURCE: Neurology 23, 2007 online.