DBG Objections to the IDSA Lyme Guidelines
24. April 2009
http://www.lymedisease.org/wp-content/u ... 774413.pdf
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- In Europe, LD is often associated with generalized dissemination throughout the entire body, including involvement of the central nervous system (CNS). Treatment should therefore be carried out with antibiotics that penetrate the CNS, irrespective of the various manifestations of the illness (arthritis, neuroborreliosis, neuropathy, acrodermatitis, carditis, encephalopathy).
- The oral antibiotics recommended by IDSA, namely low-dose doxycycline, amoxicillin and cefuroxime, do not penetrate the CNS; in contrast, minocycline, gemifloxacin and intravenous third-generation cephalosporins yield high concentrations in CSF above the minimal inhibitory concentration (MIC) for Bb (19).
- Contrary to the negative opinion of IDSA, the following antibiotics and methods of treatment have proven to be advantageous: carbapenems, ketolides and gemifloxacin (19); pulsed-dosing (20).
- The antibiotic treatment of EM displays a therapeutic failure rate of at least 10% (15, 41, 45, 47, 67-74).
- Bb could still be identified in the skin even after multiple antibiotic treatments with ceftriaxone, doxycycline and cefotaxime (47-49).
- The resistance of Bb to numerous antibiotics has been proven (61).
Objections to the proposed IDSA definition of “post-Lyme syndrome”:
- Antibiotic treatment according to the IDSA guidelines does not guarantee elimination of Bb.
- Subjective complaints may reflect ongoing infection with Bb rather than a different illness (PLS).
- The disease situation described by Steere et al (26) as “minor signs and symptoms” and by Bujak (27) as “post-Lyme syndrome” represents serious discomfort for affected patients that is comparable to decompensated cardiac insufficiency, degenerative joint diseases, pronounced diabetes mellitus or a condition after a myocardial infarction according to Klempner et al (2).
- The following facts suggest the existence of chronic LB due to persistent Bb infection:
o Persistent symptoms of LB with Bb identification despite intensive antibiotic treatment (28-46).
o Members of the Deutsche Borreliose Gesellschaft have documented 150 such cases (ISBN 978-3-640-19378-3, submitted for publication).
o There is an extensive body of literature on the existence of chronic LB (45, 50-55).
o Bb could be cultured in every stage of chronic LB (28-44), even after intensive antibiotic treatment (20, 41, 56-60).
o Numerous publications deal with chronic LB and the problems with its antibiotic treatment (20, 48-49, 62-66).
o There is a high therapeutic failure rate for the antibiotic treatment of LB in its late phase (52, 54-56, 65, 75-77).
- The so-called (according to the IDSA guidelines) adequate antibiotic therapy is subject to these restrictions:
o Since Bb can possibly resist various antibiotics (including those recommended by the IDSA guidelines) switching antibiotics may be indicated (61).
o While Bb may be resistant to erythromycin, related antibiotics appear to be suitable for treatment of LB (26, 83-85).
o Duration of treatment depends on the organic manifestations, severity and course of disease, as outlined in numerous references (2, 20, 25-26, 41, 45-47, 49, 51, 53-54, 56, 60-66, 71-73, 75, 86-94)