Am Fam Physician. 2008;77(5):700-704
AAN Releases Recommendations for Treating Lyme Disease Neuroborreliosis
Guideline source: American Academy of Neurology
Literature search described? Yes
Evidence rating system used? Yes
Published source: Neurology, July 3, 2007
Available at: http://www.neurology.org/cgi/content/full/69/1/91
Lyme disease is a multisystem, tick-borne infection that often affects the nervous system (neuroborreliosis). Although guidelines are available for the treatment of general Lyme disease, the best treatment option for neuroborreliosis is unclear. The Quality Standards Subcommittee of the American Academy of Neurology (AAN) convened an expert panel to review the literature and determine the following: (1) which antimicrobial agents are effective or ineffective, (2) whether different regimens are preferred for different manifestations, (3) what duration of therapy is needed, and (4) whether prolonged regimens are more beneficial.
The subcommittee concluded that parenteral penicillin, ceftriaxone (Rocephin), cefotaxime (Claforan), and oral doxycycline (Vibramycin) are probably safe and effective therapies for neuroborreliosis without parenchymal involvement. Oral amoxicillin and cefuroxime (Ceftin) are alternatives to doxycycline, although research on their use is lacking. Parenteral regimens are usually used to treat neuroborreliosis; however, doxycycline may be as effective in patients with some neuroborreliosis-related diseases (Table 1).
Prolonged courses of antibiotics do not improve outcomes in patients with neuroborreliosis and may be associated with adverse effects; therefore, prolonged courses are not recommended. Table 2 presents antimicrobial agents and dosages used to treat neuroborreliosis.
The subcommittee recommends future research to further clarify the best treatment regimens for neuroborreliosis.