Treatment of Lyme disease

Causal agents: Several Borrelia burgdorferi sensu late spe species have be recently described which cause different clinical forms of Lyme disease. B. garinii is implicated in neurological forms, B. burgdorferi sensu stricto in articular forms and B. afzelii in late cutaneous ions, As such disease d iversity is seen only in Europe and Asia, clinical management in Europe is somewhat different than in North America. Numerous clinical trials: A recently proposed classification of the Europea n farms of Lyme disease is based on clinical presentation: contagious condi tions or erythema migrans, early neurologic or cardiologic complications, l ate articular, neurologic or cutaneous complications Therapeutic proposals should be guided by the results of European trials, taking into account thi s classification. Adapted management: For contagious conditions or erg thema migrans, amoxici llin and doxycycline are the first intention antibiotics and should be give n for 14 to 21 days. Other antibiotic classes (macrolides, oral cephalospor ins) have not been found be more effective and should be reserved for secon d line treatment Early neurological involvement requires penicillin, a thir d generation cephalosporin or doxcycline for one month. Oral antibiotics ar e preferred in case of joint involvement using amoxicilin or doxycycline as first line therapy. A second regimen could be proposed in case of failure. Parenteral administration should be reserved for second line treatment The re is little data available on chronic atrophic acrodermatitis and protocol s are based on ceftriaxone, doxycycline or penicillin.