If Lyme disease is so easily cured why did Dattwyler ...?

An Annotated Bibliography

Lyme disease is a serious bacterial infection caused by a tick bite and affects humans and animals.

This page contains citations and highlighted extracts for medical and scientific articles from the National Institutes of Health (NIH), National Library of Medicine (NLM) MEDLINE database about Lyme disease authored or collaborated on by Raymond Dattwyler as of 23 Nov 99.

To see complete abstracts in the annotations below, click on link shown after "TITLE:" .

If Lyme disease is so easily cured with "standard antibiotic treatment", as believed by Dattwyler, why is there so much MEDLINE evidence to the contrary?

Persistence or Relapse of Lyme Disease - An Annotated Bibliography
http://www.reocities.com/HotSprings/Oasis/6455/persistence-biblio.html

Long-Term or Repeated Antibiotic Therapy for Lyme Disease - An Annotated Bibliography
http://www.reocities.com/HotSprings/Oasis/6455/therapy-biblio.html

If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler collaborate on at least 51 MEDLINE articles on the subject of Lyme disease?

MEDLINE - Dattwyler AND Lyme disease - 51 citations found on 6 Feb 01

MEDLINE - Dattwyler AND Lyme disease - 51 ABSTRACTS found on 6 Feb 01
[citation only if no abstract]



MEDLINE - All Dattwyler citations - 65 found on 6 Feb 01 [some may not be Dattwyler, RJ]

MEDLINE - All Dattwyler ABSTRACTS - 65 found on 6 Feb 01 [some may not be Dattwyler, RJ]



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler say we need a "rapid test"?

TITLE:
A rapid test for detection of Lyme disease antibodies.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=10557850&form=6&db=m&Dopt=b
AUTHORS:
Dattwyler RJ; Gomes-Solecki M
AUTHOR AFFILIATION:
SUNY at Stony Brook, Department of Medicine 11794, USA. RAYD@epo.som.sunysb.edu
SOURCE:
Am Clin Lab 1999 Jul;18(6):6



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler report that only six of 11 patients with heart problems - dilated cardiomyopathy - associated with Lyme disease completely recovered with standard antibiotic treatment?

TITLE:
[Cardiac manifestations of Lyme borreliosis with special reference to contractile dysfunction]
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9681041&form=6&db=m&Dopt=b
AUTHORS:
Seinost G; Gasser R; Reisinger E; Rigler MY; Fischer L; Keplinger A;
Dattwyler RJ; Dunn JJ; Klein W
AUTHOR AFFILIATION:
Klinischen Abteilung fur Kardiologie, Medizinischen Universitatsklinik Graz, Osterreich. gseinost@mail.som.sunysb.edu
SOURCE:
Acta Med Austriaca 1998;25(2):44-50
"Borrelia burgdorferi infection (BBI) is suggested to be associated with dilated cardiomyopathy (IDC). ...11 (24%) patients showed positive serology and a history of BBI; ...These 11 patients with BBI received standard antibiotic treatment with intravenous ceftriaxone 2 g bid for 14 days. 6 (55%) recovered completely and showed a normal LV-EF after 6 months, 3 (27%) improved their LV-EF and 2 (18%) did not improve at all."



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler report that only 85% of Lyme disease patients treated with ceftriaxone and 88% of those treated with doxycycline were "clinically cured"?

TITLE:
Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=9233865&form=6&db=m&Dopt=b
AUTHORS:
Dattwyler RJ; Luft BJ; Kunkel MJ; Finkel MF Wormser GP; Rush TJ; Grunwaldt E; Agger WA; Franklin M; Oswald D; Cockey L; Maladorno D
AUTHOR AFFILIATION:
Department of Medicine, State University of New York, Stony Brook, 11794-8161, USA.
SOURCE:
N Engl J Med 1997 Jul 31;337(5):289-94
ABSTRACT:
BACKGROUND: Localized Lyme disease, manifested by erythema migrans, is usually treated with oral doxycycline or amoxicillin. Whether acute disseminated Borrelia burgdorferi infection should be treated differently from localized infection is unknown. METHODS: We conducted a prospective, open-label, randomized, multicenter study comparing parenteral ceftriaxone (2 g once daily for 14 days) with oral doxycycline (100 mg twice daily for 21 days) in patients with acute disseminated B. burgdorferi infection but without meningitis. The erythema migrans skin lesion was required for study entry, and disseminated disease had to be indicated by either multiple erythema migrans lesions or objective evidence of organ involvement. RESULTS: Of 140 patients enrolled, 133 had multiple erythema migrans lesions. Both treatments were highly effective. Rates of clinical cure at the last evaluation were similar among the patients treated with ceftriaxone (85 percent) and those treated with doxycycline (88 percent); treatment was considered to have failed in only one patient in each group. Among patients whose infections were cured, 18 of 67 patients in the ceftriaxone group (27 percent) reported one or more residual symptoms at the last follow-up visit, as did 10 of 71 patients in the doxycycline group (14 percent, P > or = 0.05). Mild arthralgia was the most common persistent symptom. Both regimens were well tolerated; only four patients (6 percent) in each group withdrew because of adverse events. CONCLUSIONS: In patients with acute disseminated Lyme disease but without meningitis, oral doxycycline and parenterally administered ceftriaxone were equally effective in preventing the late manifestations of disease.



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler report that only 88% of Lyme disease patients treated with amoxicillin and only 76% of those treated with azithromycin "achieve[d] complete resolution of disease" and that some even relapsed?

TITLE:
Azithromycin compared with amoxicillin in the treatment of erythema migrans. A double-blind, randomized, controlled trial [see comments]
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=8610947&form=6&db=m&Dopt=b
AUTHORS:
Luft BJ; Dattwyler RJ; Johnson RC; Luger SW; Bosler EM; Rahn DW; Masters EJ; Grunwaldt E; Gadgil SD
AUTHOR AFFILIATION:
Department of Medicine, State University of New York at Stony Brook, NY 11794-8160 USA.
SOURCE:
Ann Intern Med 1996 May 1;124(9):785-91
COMMENTS:
Comment in: Ann Intern Med 1997 Mar 1;126(5):408; discussion 408-9
"OBJECTIVE: To determine whether azithromycin or amoxicillin is more efficacious for the treatment of erythema migrans skin lesions, which are characteristic of Lyme disease. ...INTERVENTION: Oral treatment with either amoxicillin, 500 mg three times daily for 20 days, or azithromycin, 500 mg once daily for 7 days. Patients who received azithromycin also received a dummy placebo so that the dosing schedules were identical. RESULTS: Of 217 evaluable patients, those treated with amoxicillin were significantly more likely than those treated with azithromycin to achieve complete resolution of disease at day 20, the end of therapy (88% compared with 76%; P=0.024). More azithromycin recipients (16%) than amoxicillin recipients (4%) had relapse (P=0.005)."



If Lyme disease is so easily diagnosed and cured with "standard antibiotic treatment" why did Dattwyler say "Diagnosis is not always straightforward, and is currently hampered by lack of a specific serologic assay"?

TITLE:
Complications of Lyme borreliosis.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=1580609&form=6&db=m&Dopt=b
AUTHORS:
Cooke WD; Dattwyler RJ
AUTHOR AFFILIATION:
Guthrie Foundation for Medical Research, Sayre, Pennsylvania 18840.
SOURCE:
Annu Rev Med 1992;43:93-103
ABSTRACT:
Lyme borreliosis is the multisystem infectious disease caused by the spirochete Borrelia burgdorferi. Complications of this infection can involve many organ systems, especially the skin, joints, nervous system, and heart. These manifestations may be acute, or evolve slowly over months or years. Diagnosis is not always straightforward, and is currently hampered by lack of a specific serologic assay. This review discusses the syndromes associated with Lyme borreliosis and addresses issues of diagnosis and treatment.



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler report that "Clinical studies have documented the efficacy of antibiotics, but therapy has failed in as many as 50% of cases of chronic infection"?

TITLE:
A perspective on the treatment of Lyme borreliosis.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=2682965&form=6&db=m&Dopt=b
AUTHORS:
Luft BJ; Gorevic PD; Halperin JJ; Volkman DJ Dattwyler RJ
AUTHOR AFFILIATION:
Department of Medicine, University of New York, Stony Brook 11794-8153.
SOURCE:
Rev Infect Dis 1989 Sep-Oct;11 Suppl 6:S1518-25
ABSTRACT:
Lyme borreliosis has become the most common tick-borne infection in the United States. Although both beta-lactam and tetracycline antibiotics have been shown to be effective in the treatment of this spirochetosis, the development of optimal therapeutic modalities has been hampered by the lack of reliable microbiologic or immunologic criteria for the diagnosis or cure of this infection. In vitro sensitivity studies have been performed by several laboratories, but there has been no standardization of the methodology for measuring either inhibitory or bactericidal levels. Clinical studies have documented the efficacy of antibiotics, but therapy has failed in as many as 50% of cases of chronic infection. Although new antibiotic regimens appear promising, the optimal treatment of this infectious disease remains to be determined. In this report we review the clinical and experimental rationale for the antibiotic regimens that we currently use and the need for a more standardized approach to treatment trials.



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler write that "no treatment is considered universally effective" and why did Dattwyler specifically note "the high resistance rate of some B. burgdorferi strains to penicillin, reported by Johnson et al. and by Preac Mursic et al."?

TITLE:
Antibiotic treatment of Lyme borreliosis.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=2686769&form=6&db=m&Dopt=b
AUTHORS:
Dattwyler RJ; Luft BJ
AUTHOR AFFILIATION:
Department of Medicine, SUNY 11794.
SOURCE:
Biomed Pharmacother 1989;43(6):421-6
ABSTRACT:
Unlike most bacterial infections, where diagnosis is by identification of the causal organism, diagnosis of infection by Borrelia burgdorferi (Lyme's borreliosis) relies mostly upon indirect techniques. This situation has some short-comings. As long as no technology permits a microbiological diagnosis of this infection, controversy will exist as to the clinical symptoms and the criteria for the cure of the disease. Despite the lack of consensus upon both the clinical definition and the treatment of Lyme's borreliosis, it is widely agreed that the affection is best understood if regarded as a progressive general infectious disease. Indeed, following a bite with local infection, there occurs a fairly rapid dissemination of the spirochaetes. In vivo therapeutic trials have shown the potential effectiveness of beta-lactams and tetracyclines, but no treatment is considered universally effective. Most of the first trials were empirical, as antibiograms were not used. Antibiotic concentrations reached with some oral therapies are too low for the protection of certain sites such as the central nervous system. In vitro studies conducted on various strains of B. burgdorferi both in the US and in Europe are very enlightening. Among the more perplexing results of some of these studies, it is worth noting the high resistance rate of some B. burgdorferi strains to penicillin, reported by Johnson et al. and by Preac Mursic et al. Therapy for Lyme's borreliosis is discussed in light of both the in vivo and in vitro studies.



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler report "We studied 17 patients who had presented with acute Lyme disease and received prompt treatment with oral antibiotics, but in whom chronic Lyme disease subsequently developed"?

TITLE:
Seronegative Lyme disease. Dissociation of specific T- and B-lymphocyte responses to Borrelia burgdorferi [see comments]
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=3054554&form=6&db=m&Dopt=b
AUTHORS:
Dattwyler RJ; Volkman DJ; Luft BJ; Halperin JJ; Thomas J; Golightly MG
AUTHOR AFFILIATION:
Department of Medicine, State University of New York, School of Medicine, Stony Brook 11794-8161.
SOURCE:
N Engl J Med 1988 Dec 1;319(22):1441-6
COMMENTS:
Comment in: N Engl J Med 1989 May 11;320(19):1279-80
"The diagnosis of Lyme disease often depends on the measurement of serum antibodies to Borrelia burgdorferi, the spirochete that causes this disorder. Although prompt treatment with antibiotics may abrogate the antibody response to the infection, symptoms persist in some patients. We studied 17 patients who had presented with acute Lyme disease and received prompt treatment with oral antibiotics, but in whom chronic Lyme disease subsequently developed. ...We conclude that the presence of chronic Lyme disease cannot be excluded by the absence of antibodies against B. burgdorferi and that a specific T-cell blastogenic response to B. burgdorferi is evidence of infection in seronegative patients with clinical indications of chronic Lyme disease."



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler judge six of 23 Lyme disease patients "treatment failures" after antibiotic treatment?

TITLE:
Treatment of late Lyme borreliosis--randomised comparison of ceftriaxone and penicillin.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=2897008&form=6&db=m&Dopt=b
AUTHORS:
Dattwyler RJ; Halperin JJ; Volkman DJ; Luft BJ
AUTHOR AFFILIATION:
Department of Internal Medicine, School of Medicine, State University of New York, Stony Brook
SOURCE:
Lancet 1988 May 28;1(8596):1191-4
ABSTRACT:
23 patients with clinically active late Lyme disease were randomly assigned to intravenous treatment with either penicillin or ceftriaxone. Of the 10 treated with penicillin, 5 were judged treatment failures; of the 13 who received ceftriaxone, only 1 did not respond. An additional 31 patients were subsequently treated with ceftriaxone 4 g/day (n = 17) or 2 g/day (n = 14); success rates in both groups were comparable to those in the cohort randomised to ceftriaxone. Patients unresponsive to ceftriaxone were more likely to have received corticosteroid treatment.



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler state "This implies that, as in syphilis, prolonged blood levels of these drugs may be necessary in order to ensure cure" and that the treatment of Lyme borreliosis was "recalcitrant to penicillin therapy"?

TITLE:
New chemotherapeutic approaches in the treatment of Lyme borreliosis.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=3056203&form=6&db=m&Dopt=b
AUTHORS:
Luft BJ; Volkman DJ; Halperin JJ; Dattwyler RJ
AUTHOR AFFILIATION:
Department of Medicine, Health Science Center, SUNY, Stony Brook 11794.
SOURCE:
Ann N Y Acad Sci 1988;539:352-61
ABSTRACT:
1. It was demonstrated that while B. burgdorferi may be sensitive to relatively small concentrations of penicillin and ceftriaxone, the organism is killed slowly. This implies that, as in syphilis, prolonged blood levels of these drugs may be necessary in order to ensure cure. In contrast, the activity of tetracycline is more rapid in its action but is more dependent on drug concentration achieved. Unfortunately, the MIC and MBC for some strains are at or above the peak level achieved under optimal conditions. 2. Increasing the concentrations of penicillin or ceftriaxone above the MIC for the organism has little effect on the rate of killing. In contrast, the killing by tetracycline can be augmented by increasing concentrations of the drug. 3. Ceftriaxone is more active than penicillin, as measured by MIC, against the five strains of B. burgdorferi tested. 4. Ceftriaxone was efficacious in the treatment of Lyme borreliosis, which was recalcitrant to penicillin therapy. In a randomized trial comparing ceftriaxone to high-dose penicillin therapy, ceftriaxone was significantly more efficacious than penicillin in the treatment of the late complications of Lyme borreliosis.



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler report on a patient who "developed severe Lyme meningoencephalitis despite receiving a full course of penicillin"?

TITLE:
Lyme meningoencephalitis: report of a severe, penicillin- resistant case.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=3649235&form=6&db=m&Dopt=b
AUTHORS:
Diringer MN; Halperin JJ; Dattwyler RJ
SOURCE:
Arthritis Rheum 1987 Jun;30(6):705-8
ABSTRACT:
Although Lyme disease frequently attacks the central nervous system, this involvement is rarely severe, and high-dose intravenous penicillin usually is adequate treatment. The patient we describe developed severe Lyme meningoencephalitis despite receiving a full course of penicillin, and his condition continued to deteriorate after reinstitution of this treatment. Intravenous chloramphenicol was used successfully and resulted in a substantial improvement.



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler report on therapy for "refractory Lyme disease"?

TITLE:
Ceftriaxone as effective therapy in refractory Lyme disease.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=3572042&form=6&db=m&Dopt=b
AUTHORS:
Dattwyler RJ; Halperin JJ; Pass H; Luft BJ
SOURCE:
J Infect Dis 1987 Jun;155(6):1322-5
[No abstract available.]



If Lyme disease is so easily cured with "standard antibiotic treatment" why did Dattwyler report that five Lyme disease patients "developed significant late complications, despite receiving tetracycline early in the course of their illness"?

TITLE:
Failure of tetracycline therapy in early Lyme disease.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?uid=3580012&form=6&db=m&Dopt=b
AUTHORS:
Dattwyler RJ; Halperin JJ
SOURCE:
Arthritis Rheum 1987 Apr;30(4):448-50
ABSTRACT:
We describe the clinical courses of 5 patients with Lyme disease who developed significant late complications, despite receiving tetracycline early in the course of their illness. All 5 patients had been treated for erythema chronicum migrans with a course of tetracycline that met or exceeded current recommendations. The late manifestations of Lyme disease included arthritis, cranial nerve palsy, peripheral neuropathy, chronic fatigue, and changes in mental function. Our findings suggest that the use of tetracycline at a dosage of 250 mg, 4 times a day for 10 days, as a treatment for early Lyme disease should be reconsidered. To determine optimal therapy for early Lyme disease, a study that compares an increased dosage of tetracycline with alternative treatments is indicated.



This document can be found at:

If Lyme disease is so easily cured why did Dattwyler ...?
http://www.reocities.com/HotSprings/Oasis/6455/dattwyler.html

For more information about Lyme disease, see:

Lots Of Links On Lyme Disease
http://www.reocities.com/HotSprings/Oasis/6455/lyme-links.html

Comments or questions concerning this page should be directed to Art Doherty.

Last updated on 31 December 1999 by
Art Doherty
Lompoc, California
doherty@utech.net


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