PUNKIN PUREMA

[Bb]

Lähettäjä: Soijuv Lähetetty: 25.5.2004 9:27

Borrelioosikausi on jälleen alkamassa. Seuraavassa on ote Burrascanon hoito-ohjeista sellaisissa tapauksissa kun punkki on purrut, mutta borrelioosin oireita ei ole ilmaantunut. Hänen mielestään antibioottihoito on syytä ottaa vaikka oireita ei olisikaan ilmaantunut, sillä ennaltaehkäisevä hoito on hänen mukaansa vaarattomampaa kuin odotella mahdollista taudin puhkeamista ja bakteerin leviämistä eri puolille elimistöön. ...."Since the likelihood of harm arising from prophylactically applied spirochetal antibiotics is low, and since treatment is inexpensive and painless, it follows that the risk benefit ratio favors tick bite prophylaxis."

Virallinen kanta esim. Suomessa on, että antibioottia ei tarvita mikäli oireita ja/tai ihomuutosta ei ilmene. Burrascanon mielestä hoidon aloittaminen perustuu selvitykseen, jossa huomioidaan esim. onko alueella tavattu borrelioosia, miten punkki poistettiin ja miten kauan se oli kiinnittyneenä ihoon. Aikuisille ja lapsille hän suosittelee 3 viikon profylaktista hoitoa ja raskaana oleville 6 viikon hoitoa joillakin seuraavista antibiooteista.


ADVANCED TOPICS IN LYME DISEASE-

DIAGNOSTIC HINTS AND TREATMENT GUIDELINES FOR LYME AND OTHER TICK BORNE ILLNESSES
INTERNATIONAL LYME AND ASSOCIATED DISEASES SOCIETY
JOSEPH J. BURRASCANO JR., M.D.

Fourteenth Edition, Copyright, November, 2002

TICK BITES - Embedded Deer Tick With No Signs or Symptoms of Lyme (see appendix): Decide to treat based on the type of tick, whether it came from an endemic area and percent infected, how it was removed, and length of attachment (nymphs: at least one day; adults: anecdotally, as little as four hours). The risk of transmission is greater if the tick is engorged, or of it was removed improperly allowing the tick's contents to spill into the bite wound. High risk bites are treated as follows (remember the possibility of coinfection!):

1) Adults: Oral therapy for 21 days.
2) Pregnancy: Amoxicillin 1000 mg q6h for 6 weeks. Test for Babesia and Ehrlichia. Alternative: Cefuroxime axetil 1000 mg q12h for 6 weeks.
3) Young Children: Oral therapy for 21 days.

ANTIBIOTIC CHOICES

ORAL THERAPY: Always check blood levels when using agents marked with an *, and adjust dose to achieve a peak level in the mid- teens and a trough greater than five. Because of this, the doses listed below may have to be raised.

Consider Doxycycline first due to concern for Ehrlichia.

*Amoxicillin- Adults: 1g q8h plus probenecid 500mg q8h; doses up to 6 grams daily are often needed Pregnancy: 1g q6h and adjust. Children: 50 mg/kg/day divided into q8h doses.
*Doxycycline- Adults: 100 mg qid with food; doses of up to 600 mg daily are often needed, as doxycycline is only effective at high blood levels. Not for children or in pregnancy. If levels are too low at tolerated doses, give parenterally.
*Cefuroxime axetil- Oral alternative that may be effective in amoxicillin and doxycycline failures. Useful in EM rashes co-infected with common skin pathogens. Adults and pregnancy: 1g q12h and adjust. Children: 125 to 500 mg q12h based on weight.
*Tetracycline- Adults only, and not in pregnancy. 500 mg tid to qid
*Erythromycin- Poor response and not recommended.
*Clarithromycin- Adults: 500 to 1000 mg q12h. Add hydroxychloroquine, 200-400 mg/d or amantadine 100-200 mg/d. Cannot be used in pregnancy or in younger children
*Azithromycin- Adults: 500 to 1200 mg/d. Adolescents: 250 to 500 mg/d. Add hydroxychloroquine, 200-400 mg/d, or amantadine 100-200 mg/d Cannot be used in pregnancy. Oral azithromycin is not as effective as clarithromycin.
*Augmentin- Cannot exceed three tablets daily due to the clavulanate, thus is given with amoxicillin. This combination can be effective when Bb beta lactamase is felt to be present.
*Chloramphenicol- Not recommended as not proven and potentially toxic.
*Metronidazole (see text): 500 to 1500 mg daily in divided doses. Adults only.

** See the - APPENDIX- RATIONALE FOR TREATING TICK BITES
An established infection by B. burgdorferi can have serious, long standing or permanent, and painful medical consequences, and be expensive to treat. Since the likelihood of harm arising from prophylactically applied spirochetal antibiotics is low, and since treatment is inexpensive and painless, it follows that the risk benefit ratio favors tick bite prophylaxis.