| georgia 2006-08-29, 4:23 pm |
| Many Lyme disease activists and patients assert that Lyme disease is a
difficult-to-treat, chronic infection that requires long-term
consumption of
broad-spectrum antibiotics. (See common beliefs about Lyme disease.)
Although
medical practice and clinical trials suggest otherwise [15], many Lyme
patients
undergo long-term intravenous antibiotic treatment. For appropriate
intravenous
antibiotic treatment, the American college of Physicians recommends
21-28 days
and various European guidelines call for 10-30 days for the commonly
used
drugs. Much longer usage has been reported among patients who have Lyme
disease
as well as patients who have been inappropriately diagnosed [16-18].
Outpatient intravenous therapy is a multi-billion-a-year business. It
remains
largely unregulated and can cost patients thousands of dollars per
week.
Price-gouging, drug markups, kickbacks, and self-referral of patients
by
physicians with financial ties to infusion companies have occurred. In
1995,
for example, Caremark, Inc., pled guilty to mail fraud charges for
entering
into illegal contracts with physicians by paying them to refer Medicaid
patients to use Caremark's infusion products. The settlement provided
for
approximately $44.5 million in civil penalties and restitution from
Caremark
[19]. In Michigan, prosecutors charged a physician and Caremark
employees with
scheming to overbill Blue Cross/Blue Shield for drugs and equipment for
patients with Lyme disease [20].
The intravenous antibiotic therapy administered to Lyme patients
sometimes has
disastrous results. During the early 1990s, the CDC described 25 cases
of
antibiotic-associated biliary complications among persons with
suspected
disseminated Lyme disease [21]. All patients had received intravenous
ceftriaxone (Rocephin) for an average of 28 days for suspected Lyme
disease.
(Ceftriaxone can form precipitates in the presence of bile salts. The
resulting
"sludge" can block the bile duct.) Twelve patients subsequently
developed
gallstones. Fourteen underwent cholecystectomy to correct bile
blockage.
Twenty-two developed catheter-associated bloodstream infections. Yet
most of
the patients lacked documented evidence of disseminated Lyme disease or
even
antibodies to B. burgdorferi. In 2000, physicians reported the death of
a
30-year-old woman who died from an infected intravenous set-up that had
been
left in place for more than two years. She was being treated for
"chronic Lyme
disease" that was unsubstantiated [22].
The risks and costs associated with such treatments were analyzed in a
1993
report whose authors concluded that most patients with a positive Lyme
antibody
titer whose only symptoms are fatigue or nonspecific muscle pains, the
risks
and costs of intravenous antibiotic therapy exceed the benefits [23].
In an Internet newsgroup post, a woman described being on intravenous
Rocephin
for 4 weeks, developing gallstones, and switching to another antibiotic
regimen
for three weeks. She also mentioned a sudden high fever, anemia, low
white cell
count, systemic pain, heart rhythm disturbance, and neurologic
symptoms. Such
descriptions are common among devout Lyme patients and provide an
unsettling
view into the desperate and dangerous measures some people will take to
treat
suspected Lyme disease. The woman ended her account by writing she had
switched
her medication to ciprofloxacin. This drug is potent but should not be
used
unnecessarily. Its adverse reactions include acute psychosis and other
neuropsychiatric reactions [24].
Another patient said he was treated at a Mexican clinic where the
doctor
admitted that he and his staff knew little about Lyme disease. The
patient
wrote, "I started on IV Rocephin (two grams a day), and later added
oral
azithromycin. My symptoms did improved, but I soon hit a treatment
plateau. We
then tried IV doxycycline, but this made me sick to my stomach." He
goes on to
describe a long list of other drugs (IV Claforan, Cefobid/Unisyn,
Premaxin, a
second round of Cefobid/Uisyn, and IV Zithromax), followed by bouts of
"severe
diarrhea" and phlebitis. Three months and some $25,000 later, DMSO was
added to
another infusion of Zithromax.
A number of these so-called "Lyme-Literate Medical Doctors (LLMD) have
been
investigated for their extensive use of powerful intravenous
antibiotics and
other unconventional practices. In New York State, the Office of
Professional
Medical Conduct (OPMC) is investigated two or LLMD about their
treatments of a
large number of patients diagnosed as having chronic Lyme disease.
Such practices are likely to draw even greater scrutiny with the recent
publication of the results of two clinical trials on chronic Lyme
disease. The
investigators noted "in these two trials, treatment with intravenous
and oral
antibiotics for 90 days did not improve symptoms more than placebo."
[15]
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