Treatment of late Lyme borreliosis.

 Infect. 1994 Nov;29,3:255-61.Treatment of late Lyme borreliosis. Wahlberg P, Granlund H,
Nyman D, Panelius J, Seppälä I.
Department of Medicine, Aland Central Hospital, Mariehamn, Finland.
The aim of this study was to develop a treatment for late Lyme borreliosis and to compare the
clinical results with serological findings before and after treatment. It was done in the Aland
Islands, population 25,000, a region endemic for Lyme borreliosis.The patients were the first
consecutive 100 patients from the Aland Islands with late Lyme borreliosis. They were
followed for at least 1 year after treatment. The clinical results of treatment were compared with
results of analyses of flagellar IgG antibodies to Borrelia burgdorferi done at the time of diagnosis
before treatment and up to 12 months afterwards.Short periods of treatment were not generally
effective. The outcome was successful in four of 13 treatments with 14 days of intravenous
ceftriaxone alone, in 50 of 56 assessable treatments with ceftriaxone followed by 100 days of
amoxycillin plus probenecid, and in 19 of 23 completed treatments with ceftriaxone followed
by 100 days of cephadroxil. Titres of IgG antibodies to B. burgdorferi flagella declined
significantly after 6 and 12 months in the patients who had successful treatments. All patients
whose final titres were less than 30% of the initial titre were in the successful group. Their titres
usually remained above the upper limit of normal for a long time but a decline to a value of less
than 30% of that before treatment was always a sign of cure.
35Symptoms and signs often improve temporarily shortly after treatment but reappear within
weeks or months. ..To conclude, we have shown that long-term treatments beginning with
intraveous ceftriaxone and continuing with amoxycillin plus probenecid or with cephadroxil
were useful in the treatment of late Lyme borreliosis.

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