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Treating Lyme Disease

Posted Aug 24 2008 1:49pm
DAVID FOLK THOMAS: Welcome to our webcast. I'm David Folk Thomas. We're going to be talking about treatments for Lyme disease. Lyme disease is spread by deer ticks. Hopefully you can prevent being infected, but if you're not so lucky we're going to tell you what you need to do, the treatments you need to get to help get rid of the disease or treat the disease.

Joining me to discuss it, on my left, is Dr. Alex McMeeking. He's an assistant professor of medicine at NYU Medical Center in New York, and also Dr. Brent Wise, a clinical instructor of medicine, also at NYU Medical Center in New York. Doctors, thanks for joining me.

Alex, let's start with you. What's the first-line treatment if you've been diagnosed with Lyme disease?

ALEX McMEEKING, MD: For most people we use a drug called doxycycline, which is a form of tetracycline. It's usually dosed one pill twice daily for anywhere from 14 to 21 days. It's not the best drug in the world to give to children, so in children we usually treat them with something called amoxicillin, which most parents will be familiar with. It's also used for other common pediatric infections.

DAVID FOLK THOMAS: Are those antibiotics?

ALEX McMEEKING, MD: Exactly, exactly. And amoxicillin is used for many other childhood infections, also. They're both quite effective in treating the majority of cases of early Lyme disease.

DAVID FOLK THOMAS: Brent, how long is this first treatment, these antibiotics, prescribed for?

BRENT WISE, MD: As Alex said, from 14 to 21 days with either doxycycline or amoxicillin. Sometimes an antibiotic called Cefuroxime is employed, as well.

DAVID FOLK THOMAS: How much of the time will this take care of it?

BRENT WISE, MD: This takes care of the vast majority of early cases. If, unfortunately, it has not been caught early and there are more late manifestations of the illness, we sometimes have to do longer courses of antibiotics and sometimes use intravenous antibiotics straight into the bloodstream.

DAVID FOLK THOMAS: Alex, what are some of those later manifestations Brent was alluding to?

ALEX McMEEKING, MD: Possibly arthritis that doesn't respond to oral therapies, neurologic Lyme disease -- sometimes people can get manifestations in the central nervous system of Lyme disease, and sometimes people can get heart involvement with conduction abnormalities and heart arrhythmias. Also, occasionally -- thank goodness, it hasn't happened too often -- but I've had a couple of people who have gotten Lyme disease during pregnancy. Again, they usually recommend using intravenous antibiotics in that situation.

DAVID FOLK THOMAS: As far as if you have some of these later stage developments -- nervous system involvement, et cetera -- then these antibiotics, what do you do beyond them?

ALEX McMEEKING, MD: That's a good question. Other than antibiotics there's not an awful lot to do. As Brent alluded to, you may sometimes go to longer courses. This is still something of a gray area. Classically, most people would treat, again for 14 to 21 days with intravenous antibiotics. I have seen situations personally and read of situations where people needed more prolonged therapy to cure their neurologic disease.

DAVID FOLK THOMAS: Brent, is Lyme disease, then curable? Do you get it removed immediately, or is it always with you?

BRENT WISE, MD: It also really depends on how early you catch it. The good news is that there is excellent data to show that even most patients who have late stage disease with some of these chronic manifestations are in fact cured with antibiotics. So there is a very high cure rate with both the early and the late stage infections.

DAVID FOLK THOMAS: Alex, I've heard about something called the lumbar puncture. Am I pronouncing that right?

ALEX McMEEKING, MD: That's correct.

DAVID FOLK THOMAS: What's that about?

ALEX McMEEKING, MD: It's commonly also known as a spinal tap. What it involves is -- a way of diagnosing if somebody has Lyme disease in their central nervous is to take out some spinal fluid from the base of their spine. It's actually quite a safe procedure. The only thing it can cause is a bad headache afterwards. They take out the spinal fluid, they look under the microscope for white blood cells, they measure for elevations in chemicals such as protein, which is often increased, and you can also actually measure through something called a polymerase chain reaction, which is a newer test for the actual bacteria that causes Lyme disease.

DAVID FOLK THOMAS: So is the bottom line with Lyme disease that you need to catch it as early as possible so you don't develop those later symptoms?

ALEX McMEEKING, MD: That's the thing. The earlier you can make a diagnosis and treat somebody, the less likely you're going to get chronic manifestations of Lyme disease. Absolutely.

DAVID FOLK THOMAS: All right, that's all the time we have. We've been discussing treating Lyme disease, and of course -- I guess I'm not saying anything new -- the best treatment would be try not to get it in the first place. But if you're aren't lucky enough, we hope you've learned something here today.

My name's David Folk Thomas. We'll see you next time.

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