Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology.

• 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).

Nyckelord

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

Syndrome

Treatment Outcome

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