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Lyme disease: modern approaches to treatment and prevention (based on international recommendations of 2020)

https://doi.org/10.37489/0235-2990-2021-66-9-10-57-63

Abstract

Lyme disease (LD) or tick-borne borreliosis affects thousands of people every year in different regions of the world, primarily in the United States and Europe. Given the great social and medical importance of this problem, an updated version of the clinical guidelines for the prevention, diagnosis and treatment of PD was published in November 2020 by a committee of experts of the Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN) and the American College of Rheumatology (ACR). This article discusses the main issues of the use of antibacterial drugs in LD. The most commonly used medications are doxycycline, amoxicillin, cefuroxime axetil, and ceftriaxone. Patients with erythema migrans receive appropriate antibiotics for 7–14 days, depending on the medication used. In case of other clinical manifestations of LD, the duration of treatment is extended to 14–28 days. Antibiotic prophylaxis is carried out using a single oral dose of 200 mg doxycycline for adults and 4.4 mg/kg (with a maximum of 200 mg) for children. This treatment scheme is highly efficient, easy to administer, and has a relatively low risk of adverse events.

About the Authors

B. S. Belov
V. A. Nasonova Research Institute of Rheumatology
Russian Federation

Boris S. Belov — D.Sc. in medicine

Moscow



L. P. Ananyeva
V. A. Nasonova Research Institute of Rheumatology
Russian Federation

Lidiya P. Ananyeva — D. Sc. in medicine, Professor, Research

Moscow



References

1. MZ RF. Klinicheskie rekomendacii. Bolezn' Lajma u vzroslyh. 2016. Available at: https://sudact.ru/law/klinicheskie-rekomendatsii-bolezn-laima-uvzroslykh-utv/klinicheskie-rekomendatsii/(in Russian)

2. Lantos P.M., Rumbaugh J., Bockenstedt L.K. et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease. Clin Infect Dis. 2021; 72 (1): 1–8. doi: 10.1093/cid/ciab049.

3. Lantos P.M., Auwaerter P.G., Wormser G.P. A systematic review of Borrelia burgdorferi morphologic variants does not support a role in chronic Lyme disease. Clin Infect Dis. 2014; 58 (5): 663–671. doi: 10.1093/cid/cit810.

4. Baker P.J., Wormser G.P. The Clinical relevance of studies on Borrelia burgdorferi persisters. Am J Med. 2017; 130 (9): 1009–01010. doi: 10.1016/j.amjmed.2017.04.014.

5. Maraspin V., Bogovič P., Rojko T. et al. Erythema migrans: Course and outcome in patients treated with rituximab. Open Forum Infect Dis. 2019; 6 (7): ofz292. doi: 10.1093/ofid/ofz292.

6. Maraspin V., Bogovič P., Rojko T. et al. Early Lyme Borreliosis in patients treated with tumour necrosis factor-alfa inhibitors. J Clin Med. 2019; 8(11): 1857. doi: 10.3390/jcm8111857.

7. Maraspin V., Ružić-Sabljić E., Lusa L., Strle F. Course and outcome of Early Lyme borreliosis in patients with hematological malignancies. Clin Infect Dis. 2015; 61 (3): 427–31. doi: 10.1093/cid/civ341.

8. Steere A.C., Grodzicki R.L., Kornblatt A.N. et al. The spirochetal etiology of Lyme disease. N Engl J Med. 1983; 308 (13): 733–740. doi: 10.1056/NEJM198303313081301

9. Steere A.C., Hutchinson G.J., Rahn D.W. et al. Treatment of the early manifestations of Lyme disease. Ann Intern Med. 1983; 99 (1): 22–26. doi: 10.7326/0003-4819-99-1-22.

10. Steere A.C., Batsford W.P., Weinberg M. et al. Lyme carditis: cardiac abnormalities of Lyme disease. Ann Intern Med. 1980; 93 (1): 8–16. doi: 10.7326/0003-4819-93-1-8.

11. Eliassen K.E., Reiso H., Berild D., Lindbæk M. Comparison of phenoxymethylpenicillin, amoxicillin, and doxycycline for erythema migrans in general practice. A randomized controlled trial with a 1-year follow-up. Clin Microbiol Infect. 2018; 24 (12): 1290–1296. doi: 10.1016/j.cmi.2018.02.028.

12. Luft B.J., Dattwyler R.J., Johnson R.C. et al. Azithromycin compared with amoxicillin in the treatment of erythema migrans. A double-blind, randomized, controlled trial. Ann Intern Med. 1996; 124 (9): 785–791. doi: 10.7326/0003-4819-124-9-199605010-00002.

13. Wormser G.P., Wormser R.P., Strle F. et al. How safe is doxycycline for young children or for pregnant or breastfeeding women? Diagn Microbiol Infect Dis. 2019; 93 (3): 238–242. doi: 10.1016/j.diagmicrobio.2018.09.015.

14. Wormser G.P., Strle F., Shapiro E.D. Is doxycycline appropriate for routine treatment of young children with Erythema migrans? Pediatr Infect Dis J. 2019 Nov; 38 (11): 1113–1114. doi: 10.1097/INF.0000000000002453.

15. IDSA handbook on clinical practice guideline development, 2018. Available at: https://idsocietyorg.app.box.com/s/zumf91rnftiv9xfzos5eot9sg2tgg2fr.

16. Klempner M.S., Baker P.J., Shapiro E.D. et al. Treatment trials for post- Lyme disease symptoms revisited. Am J Med. 2013; 126 (8): 665–669. doi: 10.1016/j.amjmed.2013.02.014.

17. Fallon B.A., Keilp J.G., Corbera K.M. et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology. 2008; 70 (13): 992–1003. doi: 10.1212/01.WNL.0000284604. 61160.2d.

18. Oksi J., Nikoskelainen J., Hiekkanen H. et al. Duration of antibiotic treatment in disseminated Lyme borreliosis: a double-blind, randomized, placebo-controlled, multicenter clinical study. Eur J Clin Microbiol Infect Dis. 2007; 26 (8): 571–581. doi: 10.1007/s10096-007-0340-2.

19. Dattwyler R.J., Luft B.J., Kunkel M.J. et al. Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease. N Engl J Med. 1997; 337 (5): 289–294. doi: 10.1056/NEJM199707313370501.

20. Caperton E.M., Heim-Duthoy K.L., Matzke G.R. et al. Ceftriaxone therapy of chronic inflammatory arthritis. A double-blind placebo controlled trial. Arch Intern Med. 1990; 150 (8): 1677–1682.

21. Steere A.C., Green J., Schoen R.T. et al. Successful parenteral penicillin therapy of established Lyme arthritis. N Engl J Med. 1985; 312 (14): 869–874. doi: 10.1056/NEJM198504043121401.

22. Dattwyler R.J., Halperin J.J., Volkman D.J., Luft B.J. Treatment of late Lyme borreliosis--randomised comparison of ceftriaxone and penicillin. Lancet. 1988; 1 (8596): 1191–1194. doi: 10.1016/s0140-6736(88)92011-9.

23. Hassler D., Zöller L., Haude M. et al. Cefotaxime versus penicillin in the late stage of Lyme disease-prospective, randomized therapeutic study. Infection. 1990; 18 (1): 16–20. doi: 10.1007/BF01644175.

24. Steere A.C., Levin R.E., Molloy P.J. et al.Treatment of Lyme arthritis. Arthritis Rheum. 1994; 37 (6): 878–888. doi: 10.1002/art.1780370616.

25. Steere A.C., Angelis S.M. Therapy for Lyme arthritis: strategies for the treatment of antibiotic-refractory arthritis. Arthritis Rheum. 2006; 54(10): 3079–3086. doi: 10.1002/art.22131.

26. Arvikar S.L., Crowley J.T., Sulka K.B., Steere A.C. Autoimmune arthritides, rheumatoid arthritis, psoriatic arthritis, or peripheral spondyloarthritis following Lyme disease. Arthritis Rheumatol. 2017; 69 (1): 194–202. doi: 10.1002/art.39866.

27. Klempner M.S., Hu L.T., Evans J. et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001; 345 (2): 85–92. doi: 10.1056/NEJM200107123450202.

28. Kaplan R.F., Trevino R.P., Johnson G.M. et al. Cognitive function in posttreatment Lyme disease: do additional antibiotics help? Neurology. 2003; 60 (12): 1916–1922. doi: 10.1212/01.wnl.0000068030.26992.25.

29. Krupp L.B., Hyman L.G., Grimson R. et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology. 2003; 60 (12): 1923–30. doi: 10.1212/01.wnl.0000071227. 23769.9e.

30. Patel R., Grogg K.L., Edwards W.D. et al. Death from inappropriate therapy for Lyme disease. Clin Infect Dis. 2000; 31 (4): 1107–1109. doi: 10.1086/318138.

31. Krause P.J., Auwaerter P.G., Bannuru R.R., Branda J.A., Falck-Ytter Y.T., Lantos P.M. et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA): 2020 Guideline on Diagnosis and Management of Babesiosis. Clin Infect Dis. 2021; 72 (2): 185–189. doi: 10.1093/cid/ciab050.


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For citations:


Belov B.S., Ananyeva L.P. Lyme disease: modern approaches to treatment and prevention (based on international recommendations of 2020). Antibiot Khimioter = Antibiotics and Chemotherapy. 2021;66(9-10):57-63. (In Russ.) https://doi.org/10.37489/0235-2990-2021-66-9-10-57-63

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