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AAN Practice Parameter: Antimicrobial Therapy of Neuroborreliosis

Experts provide evidence-based recommendations for the treatment of Lyme disease and discuss the evidence against persistent infection in "post-Lyme syndrome."

Ongoing controversy surrounds the choice of antibiotic for the treatment of neurologic Lyme disease, the appropriate duration of treatment, and whether or not chronic symptoms of "post-Lyme syndrome" are due to persistent or relapsing infection. A panel of experts from the U.S. and Europe, who have published extensively about Lyme disease, developed this evidence-based review of the treatment of neurologic Lyme disease for the American Academy of Neurology. The panel performed a literature search of studies published from 1983 to 2003. From the resulting 353 citations, 122 potentially relevant articles were reviewed in detail, of which 37 ultimately were used for the analysis.

There were sufficient data to conclude that neurologic Lyme disease in adults and children age 8 years is effectively treated with a 2-week course of parenteral penicillin, ceftriaxone, or cefotaxime. There was no evidence of antibiotic resistance in Borrelia burgdorferi. European studies provided substantial evidence that oral doxycycline is as efficacious as parenteral antibiotics in patients who have Lyme-associated meningitis, facial nerve palsy, or radiculitis. Evidence from three trials suggested a lack of benefit from prolonged antibiotic treatment of "post-Lyme syndrome" (symptoms persisting or recurring after appropriate treatment in the absence of evidence of ongoing infection).

Comment: Misunderstanding of Lyme disease has created a demand by patients with pain, fatigue, and perceived cognitive trouble to seek prolonged parenteral treatment for Lyme disease and "post-Lyme syndrome." This study provides evidence-based recommendations for appropriate types and duration of antimicrobial therapy for neurologic Lyme disease. It also provides reassurance that the disease can be treated and highlights the lack of evidence that post-Lyme syndrome is due to active B. burgdorferi infection that would require prolonged antibiotic therapy.

— Karen L. Roos, MD

Dr. Roos is John and Nancy Nelson Professor of Neurology, Indiana University School of Medicine, Indianapolis.

Published in Journal Watch Neurology October 2, 2007

Citation(s):

Halperin JJ et al. Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2007 Jul 3; 69:91.

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