In de praktijk worden bij aanhoudende klachten goede resultaten gezien met doorbehandelen bij aanhoudende klachten. Langer dan in de CBO-richtlijn 2013 wordt geopperd. En met antibiotica in combinaties. Maar een oplossing die voor iedereen werkt is er ook nog steeds niet.
Het document behandelprotocollen in schema, wel al uit 2005: http://www.lymemed.nl/protocollen/schema.pdf
Er zijn studies waarin geconcludeerd wordt dat bepaalde wat langere behandelingen met antibiotica (te) weinig of zelfs geen of maar tijdelijk effect heeft. Er zijn ook studies die juist wel laten zien dat er met langer behandelen successen worden geboekt al dan niet bij alle of een deel van de patiënten.
Dit is een greep uit de wetenschappelijk studies waar de ILADS en DBG naar refereren in hun richtlijn:
ILADS richtlijnen 2014: http://www.tandfonline.com/doi/full/10. ... 014.940900
DBG richtlijnen 2010: http://www.borreliose-gesellschaft.de/T ... elines.pdf
https://www.ncbi.nlm.nih.gov/pubmed/986 ... t=Abstract
Eur J Clin Microbiol Infect Dis. 1998 Oct;17(10):715-9.
Comparison of oral cefixime and intravenous ceftriaxone followed by oral amoxicillin in disseminated Lyme borreliosis.
Oksi J1, Nikoskelainen J, Viljanen MK.
The general outcomes of infection in patients with disseminated Lyme borreliosis after 3-4 months of therapy indicate that prolonged courses of antibiotics may be beneficial in this setting, since 90% of the patients showed excellent or good treatment responses.
https://www.ncbi.nlm.nih.gov/pubmed/843 ... t=Abstract
J Am Acad Dermatol. 1993 Feb;28(2 Pt 2):312-4.
Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persisting Borrelia burgdorferi infection.
Liegner KB1, Shapiro JR, Ramsay D, Halperin AJ, Hogrefe W, Kong L.
Further treatment with minocycline led to resolution of the erythema migrans.
https://www.ncbi.nlm.nih.gov/pubmed/923 ... t=Abstract
Clin Infect Dis. 1997 Jul;25 Suppl 1:S52-6.
Tetracycline therapy for chronic Lyme disease.
Donta ST1.
These results support the use of longer courses of treatment in the management of patients with chronic Lyme disease.
https://www.ncbi.nlm.nih.gov/pubmed/357 ... t=Abstract
J Infect Dis. 1987 Jun;155(6):1322-5.
Ceftriaxone as effective therapy in refractory Lyme disease.
Dattwyler RJ, Halperin JJ, Pass H, Luft BJ.
https://www.ncbi.nlm.nih.gov/pubmed/229 ... t=Abstract
Contemp Clin Trials. 2012 Nov;33(6):1132-42. doi: 10.1016/j.cct.2012.08.009. Epub 2012 Aug 19.
Antibiotic retreatment of Lyme disease in patients with persistent symptoms: a biostatistical review of randomized, placebo-controlled, clinical trials.
Delong AK1, Blossom B, Maloney EL, Phillips SE.
This biostatistical review reveals that retreatment can be beneficial.
https://www.ncbi.nlm.nih.gov/pubmed/175 ... t=Abstract
Clin Infect Dis. 2007 Jul 15;45(2):149-57. Epub 2007 Jun 5.
Counterpoint: long-term antibiotic therapy improves persistent symptoms associated with lyme disease.
Stricker RB1.
Prolonged antibiotic therapy may be useful and justifiable in patients with persistent symptoms of Lyme disease and coinfection with tickborne agents.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1004816/
Ann Rheum Dis. 1992 Aug; 51(8): 1007–1008.
PMCID: PMC1004816
Long term treatment of chronic Lyme arthritis with benzathine penicillin.
M A Cimmino and S Accardo
The cases are reported of two patients with chronic Lyme arthritis resistant to the recommended antibiotic regimens who were cured by long term treatment with benzathine penicillin.
https://www.ncbi.nlm.nih.gov/pubmed/19124209
Med Mal Infect. 2009 Feb;39(2):108-15. doi: 10.1016/j.medmal.2008.11.012. Epub 2009 Jan 4.
Efficacy of a long-term antibiotic treatment in patients with a chronic Tick Associated Poly-organic Syndrome (TAPOS).
Clarissou J1, Song A, Bernede C, Guillemot D, Dinh A, Ader F, Perronne C, Salomon J.
The medical management was found to be effective for symptoms, especially for patients with a high probability of chronic TAPOS (NEJM score).
https://www.ncbi.nlm.nih.gov/pubmed/14586290
Med Sci Monit. 2003 Nov;9(11):PI136-42.
Macrolide therapy of chronic Lyme Disease.
Donta ST1.
Eighty % of patients had self-reported improvement of 50% or more at the end of 3 months. After 2 months of treatment, 20% of patients felt markedly improved (75-100% of normal); after 3 months of treatment, 45% were markedly improved.
https://www.ncbi.nlm.nih.gov/pubmed/1677097
Lancet. 1991 Jul 20;338(8760):193.
Pulsed high-dose cefotaxime therapy in refractory Lyme borreliosis.
Hassler D, Riedel K, Zorn J, Preac-Mursic V.
http://www.umg-verlag.de/umwelt-medizin ... 9_kh_z.pdf
Umwelt-Medizin-Gesellschaft 2 (2009), 132–138
Patienten mit Erreger-Direktnachweis bei chronischer Lyme-Borreliose – Klinik, Labordiagnostik, Antibiotika-Therapie und Krankheitsverlauf. Eine retrospektive Studie.
Klemann, W.; Huismans, B.-D.:
Die Behandlung erstreckte sich über mindestens 6 Monate kontinuierlich antibiotisch und in manchen Fällen über einige Jahre dem Krankheitsverlauf entsprechend intermittierend. Bei 38,8 % der Patienten wurde eine Vollremission erzielt, 56,7 % der Patient en zeigten eine deutliche Besserung ihrer Symptomatik, 5,5 % der Patienten waren therapierefraktär.
https://www.ncbi.nlm.nih.gov/pubmed/12821734
Neurology. 2003 Jun 24;60(12):1923-30.
Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial.
Krupp LB1, Hyman LG, Grimson R, Coyle PK, Melville P, Ahnn S, Dattwyler R, Chandler B.
Patients assigned to ceftriaxone showed improvement in disabling fatigue compared to the placebo group
Verder zijn er meer dan 230 studies die aantonen dat borrelia 3 weken antibiotica overleeft 
voor een lijst hiervan zie: http://norvect.no/230-peer-reviewed-stu ... e-disease/Hiervan is de Embers Monkey studie de meest shockerende. De resultaten hiervan zijn 11 jaar in de doofpot gestopt en pas in 2012 gepubliceerd, nadat de richtlijn al was opgesteld.
https://www.ncbi.nlm.nih.gov/pubmed/22253822
PLoS One. 2012;7(1):e29914. doi: 10.1371/journal.pone.0029914. Epub 2012 Jan 11.
Persistence of Borrelia burgdorferi in rhesus macaques following antibiotic treatment of disseminated infection.
Embers ME1, Barthold SW, Borda JT, Bowers L, Doyle L, Hodzic E, Jacobs MB, Hasenkampf NR, Martin DS, Narasimhan S, Phillippi-Falkenstein KM, Purcell JE, Ratterree MS, Philipp MT.
En verder vond ik nog:
https://www.omicsonline.org/open-access ... 000345.pdf
J Clin Exp Dermatol Res 2016, 7:3 http://dx.doi.org/10.4172/2155-9554.1000345
The Use of Dapsone as a Novel “Persister” Drug in the Treatment of Chronic Lyme Disease/Post Treatment Lyme Disease Syndrome
Richard I Horowitz, MD* and Phyllis Freeman, PhD
We tested the efficacy of DDS in patients with chronic Lyme disease/PTLDS with tick-borne co-infections including Babesiosis, who failed commonly used antibiotic and antimalarial protocols.(...) Dapsone is a novel and effective “persister” drug for those with PTLDS and associated tick-borne co-infections who have failed classical antibiotic protocols.
https://www.ncbi.nlm.nih.gov/pubmed/22361005
Med Hypotheses. 2012 May;78(5):606-15. doi: 10.1016/j.mehy.2012.01.037. Epub 2012 Feb 22. Published by Elsevier Ltd.
Long term antibiotic therapy may be an effective treatment for children co-morbid with Lyme disease and autism spectrum disorder.
Kuhn M1, Grave S, Bransfield R, Harris S.
All of the children's scores on the SAP-O assessment improved after 6 months of antibiotic therapy. The assessors also reported anecdotal data of improved speech, eye contact, sleep behaviors, and a reduction of repetitive behaviors.
https://www.ncbi.nlm.nih.gov/pubmed/20228716
Minerva Med. 2010 Feb;101(1):1-7.
Safety of intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease.
Stricker RB, Green CL, Savely VR, Chamallas SN, Johnson L.
With proper IVD care, the risk of extended antibiotic therapy in these patients appears to be low.
https://www.ncbi.nlm.nih.gov/pubmed/18971914
Minerva Med. 2008 Oct;99(5):489-96.
Severity of Lyme disease with persistent symptoms. Insights from a double-blind placebo-controlled clinical trial.
Cameron D.
The improvements in the SF-36 measure of QOL for subjects randomized to amoxicillin vs. placebo was significant (46% vs 18%, P=0.007).
https://www.ncbi.nlm.nih.gov/pubmed/7884218
J Infect. 1994 Nov;29(3):255-61.
Treatment of late Lyme borreliosis.
Wahlberg P, Granlund H, Nyman D, Panelius J, Seppälä I.
The outcome was successful in four of 13 treatments with 14 days of intravenous ceftriaxone alone, in 50 of 56 assessable treatments with ceftriaxone followed by 100 days of amoxycillin plus probenecid, and in 19 of 23 completed treatments with ceftriaxone followed by 100 days of cephadroxil.
https://www.ncbi.nlm.nih.gov/pubmed/9158807
Microb Drug Resist. 1995 Winter;1(4):341-4.
Cases of Lyme borreliosis resistant to conventional treatment: improved symptoms with cephalosporin plus specific beta-lactamase inhibition.
Gasser R, Reisinger E, Eber B, Pokan R, Seinost G, Berglöff J, Horwarth R, Sedaj B, Klein W.
At the end of treatment, patients were symptom free and have remained so for the following 12 months.
http://www.lymeeducation.com/reference_ ... isease.pdf
Journal of Spirochetal and Tick-Borne Diseases 6(4):94-102, 1999. © 1999 Lyme Disease Foundation, Inc.
Repeated Antibiotic Treatment in Chronic Lyme Disease
Brian A. Fallon, MD, Felice Tager, PhD, John Keilp, PhD, Nicola Weiss, PhD, Michael R. Liebowitz, MD, Lesley Fein, MD, Kenneth Liegner, MD
This uncontrolled study suggests that repeated antibiotic treatment can be beneficial, even among patients who have been previously treated and even among patients who are currently Western blot negative, with the intravenous route of treatment being the most effective.
https://www.ncbi.nlm.nih.gov/pubmed/15337633
Eur J Med Res. 2004 Jul 30;9(7):334-6.
Clinical effects of fluconazole in patients with neuroborreliosis.
Schardt FW1.
At the end of treatment eight patients had no borreliosis symptoms and remained free of relapse in a follow-up examination one year later. In the remaining four patients, symptoms were considerably improved
Deze verzameling is nog niet volledig dus als iemand aanvullingen heeft graag.
Josie
