This article, published May 10, 2011 by Shoreview (MN) Press (www.presspubs.com) is reproduced with kind permission of the publisher.
Longer Therapy for Lyme
By Debra Neutkens, Shoreview Press staff writer
Minnesota Lyme Association spokesperson Dr. Betty Maloney recently presented her case on the shortcomings of current antibiotic protocols in the Wisconsin Medical Journal. [Her article, “The management of Ixodes scapularis [deer tick] bites in the Upper Midwest,” calls for a protocol that addresses the significant dual risk of tick-borne anaplasmosis and Lyme infection in the region - explaining that anaplasmosis doesn’t normally produce a tell-tale rash, mimicks other diseases, and has not been the subject of prophylactic treatment studies. Other infective tick-borne bacteria will be endemic in other regions.]
Extended antibiotic use for Lyme disease is a controversial topic Maloney has defended again and again. The family physician from Wyoming, Minnesota is a proponent of earlier, stronger, long-term antibiotic therapy for the infected.
Typical treatment for preventing Lyme disease within 72 hours (3 days) of a bite is a single dose of 200 mg oral doxycycline, as recommended by the Infectious Diseases Society of America.
Maloney said there are problems with that guideline; it’s based on research that is “scant and faulty” and may not be appropriate for use in the upper Midwest.
As an alternative, she said, physicians could offer 100 mg of doxycycline twice daily for 10 to 20 days to patients bitten by a deer tick.
In regard to the research, Maloney said:
• One trial relied on the presence of a rash to indicate infection, ignoring subjects who had other evidence of early Lyme but no rash (the Centers for Disease Control estimates at least 30% of patients with Lyme disease never develop a rash).
• One trial also used a six-week follow-up - too short a time to allow for development of late Lyme disease.
The single dose of antibiotics carries another risk, Maloney said.
• Patients receiving one dose run the risk of testing negative for Lyme when they’re still infected;
• The dose can also alter the immune response and diminish antibody production.
“That is the worst possible scenario,” she said. “Not only did you not prevent Lyme, but now it’s harder for the patient to be treated.”
According to the National Institute of Allergy and Infectious Diseases, 100,000 cases of Lyme disease are diagnosed in the U.S. annually. In Minnesota, 20.2 of every 100,000 people have Lyme, ranking the state 11th highest in the U.S.
The Minnesota Lyme Association suggests patients seeing a doctor for a tick bite bring a copy of Maloney’s paper, available on www.mnlyme.com. Maloney owns Partnership for Healing and Health Ltd., a provider of accredited continuing medical education on Lyme disease.
About Lyme disease [and risk of infection]
Maloney’s paper… is timely. Ticks are out - they start moving and eggs begin hatching once ground temperatures get into the 40s - and May is National Lyme Disease Prevention Month.
Ixodes scapularis is commonly called the black-legged or deer tick. Those harboring Borrelia burgorferi bacterium are to blame for Lyme disease.
Roughly 33% of deer ticks are infected with B. burgorferi in Minnesota. In the heavier-infested north central and east central areas, the Department of Health and the Metropolitan Mosquito Control District estimate 66% of deer ticks are infected with the Lyme bacterium.
According to Maloney, the risk of getting Lyme disease depends on how long the tick is attached and the rate of infection among ticks in the area.
• Attachment times of less than 24 hours lead to little chance of transmitting B. burgdorferi, she said.
• At 60 hours [2-1/2 days], 50% of infected nymphs will transmit the bacteria
• And ticks feeding 96 hours [4 days] or longer transmit Lyme 94% of the time.
If a nymphal tick feeds for 60 hours in an area where infection rate is 30%, that bite has a 15% chance of transmitting bacteria to a human host.
The same tick can transmit the anaplasmosis bacterium in a matter of hours, Maloney added.
Avoiding bites from deer ticks in the first place remains the best way to prevent Lyme disease and/or anaplasmosis. Judicious use of permethrin and repellants containing DEET help reduce risk of infection.
For more information on Lyme disease prevention, visit www.mnlyme.com.
Note: This information has not been evaluated by the FDA. It is general information and is not meant to prevent, diagnose, treat or cure any illness. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it with your professional healthcare team.