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When Are Antibiotics for Lyme Disease Medically Necessary?
Date:6/5/2008

Guidelines downplay antibiotic treatment for longstanding symptoms

PORTLAND, Ore., June 5 /PRNewswire/ -- As good weather brings people outdoors and into the woods, it also exposes them to tick bites that can result in Lyme disease, one of the fastest growing infectious diseases in the United States. A microscopic bacterial organism, Borrelia burgdorferi, carried by the Ixodes tick causes the Lyme infection. Although the incidence of Lyme disease remains low -- about 100,000 cases each year -- that's a big jump over the 16,000 cases the Center for Disease Control (CDC) noted in 1999.

The CDC and Infectious Diseases Society of America (IDSA) have de-emphasized antibiotics in the treatment of Lyme disease.

"The IDSA released guidelines that are more restrictive about using antibiotics in the three stages of Lyme disease," said Dr. Skip Freedman, Executive Medical Director at AllMed Healthcare Management, a leading independent review organization.

According to Freedman, doctors should consider other diagnostic possibilities first. Prior to diagnosing Lyme disease, they must verify that a patient has recently been in a place where the disease is epidemic -- usually the coastal northeast, mid-Atlantic region, Wisconsin, Minnesota or northern California. Then doctors should follow the current CDC and IDSA guidelines for prescribing courses of antibiotic treatment.

During the first stage of the disease, infected patients may develop a bull's-eye rash. In the second stage, they may show multiple skin lesions that coincide with flu-like symptoms, followed by nonspecific muscular, skeletal, arthritic, neuralgic, psychiatric and even cardiac symptoms.

"A diagnosis of Lyme disease should never be made based on initial blood test screening alone," Freedman said. Doctors must run more specific serologic tests, including an enzyme-linked immunoassay and a Western blot test to check if Lyme disease antibodies are present.

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SOURCE AllMed Healthcare Management
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