TREATMENT Introduction
A tick bite, which leads to infection with B. burgdorferi s.l., can result in an infection which remains subclinical (asymptomatic) and is self-limiting, leaving only specific IgG antibodies as sign of an infection, i.e. a "serological scar". All cases with clinical symptoms should, however, receive antibiotic treatment, so as to prevent progression to later stages.The type of antibiotic treatment given will depend on the clinical manifestations but also on antibiotic strategies in different parts of Europe. The choice of drugs is governed by local policies concerning availability of drugs in different countries, on economical considerations and on national guidelines aimed at preventing the development of drug resistance. The following information on Lyme borreliosis treatment reports current practice in Europe. It is not all-inclusive and minority strategies are excluded. These minority strategies often include longer periods than is normally recommended and are not based on controlled studies. Controlled studies indicate that shorter treatment regimens are preferable to longer ones (Klempner, et al.,2001, New Eng. J. Med. 345, 85-92, Wormser et al., 2001, Wiener. Klin. Wochenschr. 114, 613-615).
In a small proportion of patients symptoms do not appear to respond satisfactorily to antibiotic therapy. Occasionally relapses occur, especially if unrecommended antibiotics such as the majority of the macrolides, are used and in such cases a second course of antibiotics may be required. Occasionally patients show persistent synovitis months or years after 2-3 months of antibiotic therapy. This so-called antibiotic-refractory Lyme arthritis, which is more frequent in the US, is thought to be due to a form of autoimmunity, though persistent infection has also been implicated. Patients with “chronic” LB or post-LB syndrome show symptoms such as musculoskeletal pain, neurocognitive symptoms and/or fatigue, similar to chronic fatigue syndrome or fibromyalgia, which persist despite prolonged antibiotic treatment. There is rarely evidence for the presence of spirochaetes in these cases and symptomatic therapy is generally recommended. Please read the disclaimer before accessing this information.
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