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Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.
Neurology. 2007 Jul 03; 69(1):91-102.Neur

Abstract

OBJECTIVE

To provide evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome. Three questions were addressed: 1) Which antimicrobial agents are effective? 2) Are different regimens preferred for different manifestations of nervous system Lyme disease? 3) What duration of therapy is needed?

METHODS

The authors analyzed published studies (1983-2003) using a structured review process to classify the evidence related to the questions posed.

RESULTS

The panel reviewed 353 abstracts which yielded 112 potentially relevant articles that were reviewed, from which 37 articles were identified that were included in the analysis.

CONCLUSIONS

There are sufficient data to conclude that, in both adults and children, this nervous system infection responds well to penicillin, ceftriaxone, cefotaxime, and doxycycline (Level B recommendation). Although most studies have used parenteral regimens for neuroborreliosis, several European studies support use of oral doxycycline in adults with meningitis, cranial neuritis, and radiculitis (Level B), reserving parenteral regimens for patients with parenchymal CNS involvement, other severe neurologic symptomatology, or failure to respond to oral regimens. The number of children (> or =8 years of age) enrolled in rigorous studies of oral vs parenteral regimens has been smaller, making conclusions less statistically compelling. However, all available data indicate results are comparable to those observed in adults. In contrast, there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post-Lyme syndrome (Level A).

Authors+Show Affiliations

Department of Neurosciences, Overlook Hospital, NYU School of Medicine, Summit, NJ, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Practice Guideline
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17522387

Citation

Halperin, J J., et al. "Practice Parameter: Treatment of Nervous System Lyme Disease (an Evidence-based Review): Report of the Quality Standards Subcommittee of the American Academy of Neurology." Neurology, vol. 69, no. 1, 2007, pp. 91-102.
Halperin JJ, Shapiro ED, Logigian E, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007;69(1):91-102.
Halperin, J. J., Shapiro, E. D., Logigian, E., Belman, A. L., Dotevall, L., Wormser, G. P., Krupp, L., Gronseth, G., & Bever, C. T. (2007). Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology, 69(1), 91-102.
Halperin JJ, et al. Practice Parameter: Treatment of Nervous System Lyme Disease (an Evidence-based Review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2007 Jul 3;69(1):91-102. PubMed PMID: 17522387.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. AU - Halperin,J J, AU - Shapiro,E D, AU - Logigian,E, AU - Belman,A L, AU - Dotevall,L, AU - Wormser,G P, AU - Krupp,L, AU - Gronseth,G, AU - Bever,C T,Jr AU - ,, Y1 - 2007/05/23/ PY - 2007/5/25/pubmed PY - 2007/7/21/medline PY - 2007/5/25/entrez SP - 91 EP - 102 JF - Neurology JO - Neurology VL - 69 IS - 1 N2 - OBJECTIVE: To provide evidence-based recommendations on the treatment of nervous system Lyme disease and post-Lyme syndrome. Three questions were addressed: 1) Which antimicrobial agents are effective? 2) Are different regimens preferred for different manifestations of nervous system Lyme disease? 3) What duration of therapy is needed? METHODS: The authors analyzed published studies (1983-2003) using a structured review process to classify the evidence related to the questions posed. RESULTS: The panel reviewed 353 abstracts which yielded 112 potentially relevant articles that were reviewed, from which 37 articles were identified that were included in the analysis. CONCLUSIONS: There are sufficient data to conclude that, in both adults and children, this nervous system infection responds well to penicillin, ceftriaxone, cefotaxime, and doxycycline (Level B recommendation). Although most studies have used parenteral regimens for neuroborreliosis, several European studies support use of oral doxycycline in adults with meningitis, cranial neuritis, and radiculitis (Level B), reserving parenteral regimens for patients with parenchymal CNS involvement, other severe neurologic symptomatology, or failure to respond to oral regimens. The number of children (> or =8 years of age) enrolled in rigorous studies of oral vs parenteral regimens has been smaller, making conclusions less statistically compelling. However, all available data indicate results are comparable to those observed in adults. In contrast, there is no compelling evidence that prolonged treatment with antibiotics has any beneficial effect in post-Lyme syndrome (Level A). SN - 1526-632X UR - https://www.unboundmedicine.com/medline/citation/17522387/Practice_parameter:_treatment_of_nervous_system_Lyme_disease__an_evidence_based_review_:_report_of_the_Quality_Standards_Subcommittee_of_the_American_Academy_of_Neurology_ L2 - http://www.neurology.org/cgi/pmidlookup?view=long&pmid=17522387 DB - PRIME DP - Unbound Medicine ER -