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Controversies in the use of antimicrobials for the prevention and treatment of Lyme disease

Kontroversen in der präventiven und therapeutischen Anwendung von Antibiotika by Lyme-Krankheit

  • Special Addendum — Part II
  • Therapy And Prophylaxis In Lyme Borreliosis
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Summary

Unanswered questions in the management of patients with Lyme disease or those who have hadIxodes tick bites include: Is antimicrobial therapy effective in preventing Lyme disease during the incubation period of the infection? Which oral agents are most effective in treatment of Lyme disease? Are macrolides efficacious? And, for how long a time period should antimicrobial therapy be given? Potentially useful insights into these questions can be gained by examining experience with other spirochetal infections. Using this information, in conjunction with existing data from recent studies on Lyme borreliosis, tentative answers to these questions can be formulated. Based on this analysis, it would be anticipated that a short course of antibiotic therapy, perhaps even a single dose, will be effective in preventing Lyme disease after a tick bite. Beta-lactam antibiotics such as amoxicillin, and tetracycline preparations, such as doxycycline, are the mainstays of oral therapy for treatment of active infection. Macrolides are less effective, but their utility is likely to be improved if they are given in maximal dosage. There is no convincing evidence for extending treatment of early Lyme disease beyond 14 days. There is also no evidence that longer therapy is more efficacious for other manifestations of Lyme disease, although this issue deserves further study.

Zusammenfassung

Folgende Fragen sind in der Behandlung von Patienten mit Lyme-Krankheit oder Personen nach Zeckenstich noch ungelöst: Kann die Lyme-Krankheit durch Antibiotikatherapie während der Inkubationszeit der Infektion verhütet werden? Welche oralen Substanzen sind in der Therapie der Lyme-Krankheit am effizientesten? Sind Makrolide wirksam? Wie lange sollte eine Antibiotikatherapie durchgeführt werden? Erfahrungen mit anderen durch Spirochäten verursachten Krankheiten bieten möglicherweise brauchbare Erkenntnisse zu diesen Fragen. In Verbindung mit verfügbaren Daten aus neuen Studien zur Lyme-Borreliose erlauben diese Informationen möglicherweise eine vorläufige Antwort. Demnach ist davon auszugehen, daß eine Kurzzeittherapie, eventuell mit einer Einzeldosis, die Lyme-Krankheit nach Zeckenstich verhindern kann. β-Laktam-Antibiotika wie Amoxicillin und Tetracycline wie Doxycyclin sind die wichtigsten Substanzen für die orale Behandlung der aktiven Infektion. Makrolide sind weniger wirksam, doch kann ihre Effizienz wahrscheinlich verbessert werden, wenn sie in Höchstdosis verabreicht werden. Es gibt keine überzeugenden Daten dafür, daß eine Verlängerung der Therapie der frühen Lyme-Krankheit über 14 Tage hinaus von Vorteil ist. Auch fehlt es an Beweisen dafür, daß eine längerdauernde Therapie bei anderen Manifestationsformen der Lyme-Krankheit die Ergebnisse verbessert, doch bedarf dieses Thema weiterer Untersuchungen.

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  1. Division of Infectious Diseases, Macy Pavilion, Westchester County Medical Center, Room 209 SE, 10595, Valhalla, NY, USA

    G. P. Wormser M. D.

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Wormser, G.P. Controversies in the use of antimicrobials for the prevention and treatment of Lyme disease. Infection 24, 178–181 (1996). https://doi.org/10.1007/BF01713335

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