ILADS treatment

[Guest guest]

Here is what ILADs says-I know it is just a guide but it looks like

this dr. is on course.

Dosage

Increasingly, clinicians recommend that certain drugs used for Lyme

disease be given at higher daily doses: for example, 3,000–6,000 mg

of amoxicillin, 300–400 mg doxycycline, and 500–600 mg of

azithromycin. Some clinicians prescribe antibiotics using blood

levels to guide higher doses. Close monitoring of complete blood

counts and chemistries are also required with this approach.

With higher doses, there may be an increase in adverse events in

general and gastrointestinal problems in particular. Acidophilus has

reportedly reduced the incidence of Clostridium difficile colitis and

non-C. difficile antibiotic-related diarrhea.

Serious adverse effects of antibiotics, however, were less common

than previous estimates. In a recent clinical trial of chronic Lyme

disease, the overall serious adverse event rate was 3% after three

months of antibiotics, including 1 month of intravenous antibiotics.

Clinicians who have experience with higher dose antibiotic therapy

must balance the benefit of higher drug levels achieved with this

therapy against the modest risk of gastrointestinal and other side

effects.

Duration of Therapy

Because of the disappointing long-term outcome with shorter courses

of antibiotics, the practice of stopping antibiotics to allow for a

delayed recovery is no longer recommended for patients with

persistent, recurrent, and refractory Lyme disease. Reports show

failure rates of 30–62% within 3 years of short-course treatment

using antibiotics thought to be effective for Lyme disease.

Conversely for neurologic complications of Lyme disease, doubling the

length of intravenous ceftriaxone treatment from 2 to 4 weeks

improved the success rate from 66 to 80%.

The management of chronic Lyme disease must be individualized, since

patients will vary according to severity of presentation and response

to previous treatment.

Concurrent risk factors (i.e., coinfections, previous treatment

failures, frequent relapses, neurologic involvement, or previous use

of corticosteroids) or evidence of unusually severe Lyme disease

should lead to the initiation of prolonged and/or intravenous

antibiotic treatment. Physicians should always assess the patient's

response to treatment before deciding on appropriate duration of

therapy (i.e., weeks versus months).