"prophylactic treatment was totally ineffective when delivered 2days after tick removal."
This prophylactic method, based before solely on opinion, was brought to Americans by doctors from Yale (that most likely subscribe to birth control being "two aspirin held firmly between the knees."
What makes this so dangerous is that people came back in disabled and were told it couldn't be Lyme because they had been treated. So they are sick, disabled and treated with dangerous things with severe side effects that cannot possibly help them and kept from the treatment that would help them. 10 long long years this took. GBA.
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----- Original Message -----
From: Phyllis Mervine
To: Sent: Wednesday, March 21, 2012 1:23 PM
Subject: [lymenet_leaders] "prophylactic treatment was totally ineffective when delivered ?2days after tick removal."
Dear People,
This is an updated version that includes Betty Maloney, MD's published paper, omitted from my message yesterday. Use this one.
Since 2001 the IDSA has been recommending preventive treatment of a single dose of doxycyline for tickbites under certain narrow conditions. Piesman et al. have just published a new article concluding that if the treatment is given as little as 24 hours after the bite, only 47% of the mice were cured. Piesman also concludes that "Prophylactic treatment was totally ineffective when delivered ?2days (48hrs) after tick removal." The IDSA recommends treating if
Tick is estimated to have been attached for ?36 hours (based upon how engorged the tick appears or the amount of time since outdoor exposure)
Antibiotic treatment can begin within 72 hours of tick removal
In the past 11 years, the misinformation has spread widely on the internet. Your mission, should you choose to accept it, is to seek out sites displaying the inaccurate information and ask them to correct it. I have prepared language below for you to use. Simply cut and paste. The quote is from the IDSA recommendations so it's likely to be quoted exactly on each website. Let's see if we can turn this around before another 11 years goes by. You will be saving lives.
To avoid unnecessary duplication, let us know when you do it and if you get any responses. I am doing http://www.uptodate.com/contents/patient-information-what-to-do-after-a-tick-bite-to-prevent-lyme-disease-beyond-the-basics
Guess who the editor is? Allen Steere. I found the emails for custom service, editorial, education, and media. I sent to all. It took a little while to figure it all out and to put this together, but it worked fine.
It will be easier for them to fix if you give the URL where the misinformation occurs.
It might be worth contacting newspapers and magazines that have published the info but you'll need to change the language a bit to encourage them to publish a new article based on the updated info. If they thought it was good the first time, they might like the correction, too.
Phyllis Mervine
LymeDisease.org
Please correct this misinformation (based on a 2001 paper) on your website. [PUT THE URL HERE]
"If the person meets ALL of the above criteria, the recommended dose of doxycycline is a single dose of 200 mg for adults and 4 mg/kg, up to a maximum dose of 200 mg, in children ? 8 years"
In 2004 Zeidner et al. noted that the "sustained release" doxy was curative, but regular doxy only 43% effective. [ Antimicrob Agents Chemother. 2004 Jul;48(7):2697-9. Sustained-release formulation of doxycycline hyclate for prophylaxis of tick bite infection in a murine model of Lyme borreliosis.]
In 2008 Dolan et al. reported on the success of 14 days of exposure to antibiotic bait formulations..
Am J Trop Med Hyg. 2008 May;78(5):803-5.
A doxycycline hyclate rodent bait formulation for prophylaxis and treatment of tick-transmitted Borrelia burgdorferi.
Dolan MC, Zeidner NS, Gabitzsch E, Dietrich G, Borchert JN, Poché RM, Piesman J.
Abstract
The prophylactic and curative potential of doxycycline hyclate formulated in a rodent bait at concentrations of 250 and 500 mg/Kg was evaluated in a murine model of Lyme borreliosis. Both bait formulations prevented tick-transmitted Borrelia burgdorferi infection in 100% of C3H/HeJ mice (N = 16), as well as cured acute, established infection in mice (N = 8) exposed to bait for 14 days. Spirochete infection was cleared in 88.9% to 100% of infected nymphs feeding on mice fed 250 and 500 mg/Kg antibiotic bait formulations, respectively. These data provide evidence for exploring alternative techniques to prevent transmission of Lyme disease spirochetes.
In 2011 Wisconsin Journal of Medicine published a review detailing the failure of one-dose doxycycline prophylaxis and proposing an alternative, more effective treatment option. (Maloney, B. The management of Ixodes scapularis bites in the upper Midwest. WMJ. 2011 Apr;110(2)
8-81; quiz 85.) The full text article is available at http://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/110/2/78.pdf
This month Peisman and Hoigaard note that "prophylactic treatment was totally ineffective when delivered ?2days after tick removal." [2 days = 48 hrs]
Ticks Tick Borne Dis. 2012 Mar 13. [Epub ahead of print]
Protective value of prophylactic antibiotic treatment of tick bite for Lyme disease prevention: An animal model.
Piesman J, Hojgaard A.
Abstract
Clinical studies have demonstrated that prophylactic antibiotic treatment of tick bites by Ixodes scapularis in Lyme disease hyperendemic regions in the northeastern United States can be effective in preventing infection with Borrelia burgdorferi sensu stricto, the Lyme disease spirochete. A large clinical trial in Westchester County, NY (USA), demonstrated that treatment of tick bite with 200mg of oral doxycycline was 87% effective in preventing Lyme disease in tick-bite victims (Nadelman, R.B., Nowakowski, J., Fish, D., Falco, R.C., Freeman, K., McKenna, D., Welch, P., Marcus, R., Agúero-Rosenfeld, M.E., Dennis, D.T., Wormser, G.P., 2001. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N. Engl. J. Med. 345, 79-84.). Although this excellent clinical trial provided much needed information, the authors enrolled subjects if the tick bite occurred within 3days of their clinical visit, but did not analyze the data based on the exact time between tick removal and delivery of prophylaxis. An animal model allows for controlled experiments designed to determine the point in time after tick bite when delivery of oral antibiotics would be too late to prevent infection with B. burgdorferi. Accordingly, we developed a tick-bite prophylaxis model in mice that gave a level of prophylactic protection similar to what had been observed in clinical trials and then varied the time post tick bite of antibiotic delivery. We found that two treatments of doxycycline delivered by oral gavage to mice on the day of removal of a single potentially infectious nymphal I. scapularis protected 74% of test mice compared to controls. When treatment was delayed until 24h after tick removal, only 47% of mice were protected; prophylactic treatment was totally ineffective when delivered ?2days after tick removal. Although the dynamics of antibiotic treatment in mice may differ from humans, and translation of animal studies to patient management must be approached with caution, we believe our results emphasize the point that antibiotic prophylactic treatment of tick bite to prevent Lyme disease is more likely to be efficacious if delivered promptly after potentially infectious ticks are removed from patients. There is only a very narrow window for prophylactic treatment to be effective post tick removal.
