Abstract | OBJECTIVE: 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).
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Authors | J J Halperin, E D Shapiro, E Logigian, A L Belman, L Dotevall, G P Wormser, L Krupp, G Gronseth, C T Bever Jr, Quality Standards Subcommittee of the American Academy of Neurology |
Journal | Neurology
(Neurology)
Vol. 69
Issue 1
Pg. 91-102
(Jul 03 2007)
ISSN: 1526-632X [Electronic] United States |
PMID | 17522387
(Publication Type: Journal Article, Practice Guideline, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anti-Bacterial Agents
- Penicillins
- Doxycycline
- Prednisone
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Topics |
- Administration, Oral
- Adult
- Anti-Bacterial Agents
(administration & dosage, adverse effects, pharmacology, therapeutic use)
- Borrelia burgdorferi
(drug effects)
- Child
- Chronic Disease
- Cognition Disorders
(etiology)
- Cranial Nerve Diseases
(drug therapy, etiology)
- Doxycycline
(administration & dosage, therapeutic use)
- Drug Administration Schedule
- Drug Therapy, Combination
- Evidence-Based Medicine
- Fatigue
(etiology)
- Female
- Headache
(etiology)
- Humans
- Infusions, Parenteral
- Lyme Neuroborreliosis
(complications, diagnosis, drug therapy)
- Male
- Penicillins
(administration & dosage, therapeutic use)
- Prednisone
(administration & dosage, therapeutic use)
- Randomized Controlled Trials as Topic
- Syndrome
- Treatment Outcome
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