Antibiotic Therapy For Lyme

The controversy over antibiotics for Lyme disease has gotten so hot that the National Institutes of Health has come up with a $4 billion study into the long-term use of antibiotics in patients.

However, as that study gets going, Sen. Dodd of Connecticut and his colleagues from New York and New Jersey- three states heavily impacted by Lyme disease- have asked the General Office of accounting to investigate the U.S. Department of Health and Human Services agencies, which includes the NIH and CDC. Among other issues, the Congressional leaders want to know if federal officials have become biased in favor of short-term treatment, allowing that point of view to influence decisions on Lyme disease funding, research and surveillance measures.

Sen. Dodd and his colleagues want an answer in six months. Anyone who ventures off-pavement in Lyme-disease country needs to take precautions against the ticks that carry this serious bacterial infection. The ticks are most abundant in the Northeast, in the upper Midwest, and along the California coast. They infect at least 15,000 Americans a year, according to the national Centers for Disease Control and Prevention (CDC), though the agency concedes that it receives reports of perhaps only 10 percent of actual cases.

The LYMErix vaccine, introduced in 2005, is likely to cut that toll, but it does not provide total protection and is not for everyone. What follows can help you decide if the vaccine is for you or whether you're better off relying solely on insect repellents and other simple preventive measures.

- Vaccination guidelines. The LYMErix vaccine is recommended for people from 15 to 70 years of age who frequently work or play for prolonged periods in wooded, overgrown, or grassy areas where deer, mice, songbirds, squirrels, and other critters carrying infected ticks are found. Your doctor can help you decide if your outdoor exposure, the local prevalence of disease-carrying ticks, and the risk of side effects make the vaccine worthwhile for you. Vaccination is not recommended for pregnant women, according to the CDC. It is not known whether the vaccine is safe for people with immune-system deficiencies or musculoskeletal diseases, including rheumatoid arthritis. The vaccine is given in three doses: an initial shot typically in February or March; a second shot a month later that halves your risk of catching Lyme disease that spring and summer; and a final shot a year after the first that reduces your risk by 78 percent overall.

Perhaps most important, the vaccine also provides 83 percent protection after two doses and full protection after three doses against “asymptomatic” Lyme disease. That version is particularly worrisome because symptoms may not appear until severe complications - such as arthritis and neurologic problems - develop months or years later.

The most common vaccine side effect is soreness at the injection site; fewer people experience muscle aches, fever, and other flulike symptoms lasting two or three days. The vaccine series costs $ 200 to $ 300. Check with your health-insurance plan to find out if costs are covered. Lyme disease treatments

LYMErix provides less than full protection in Lyme disease treatments and none against other tick- and insect-borne diseases, people who have been vaccinated still need to take other protective measures.

When walking in the woods or tall grass, wear long sleeves and tuck pants cuffs into socks or boots to protect your skin from insects. For extra protection, spray insect repellent (see below) on exposed skin and on the outside of your shoes, socks, and pants. Choose light-colored clothing so you can see ticks and remove them. At the end of the day, inspect yourself for ticks, which may be as small as a poppy seed. If you find one attached to your skin, don't panic; it is unlikely for a tick to transmit the Lyme bacterium in less than 36 hours. Remove the tick with tweezers, grasping it close to your skin and applying steady pressure away from the skin to make sure all parts are removed. Afterward, disinfect the area, your hands, and the tweezers.

Insect repellents. Check the label of insect repellents before purchasing to find one that is effective against ticks as well as other insects. And make sure that there's no warning against using it on clothing. Deet, the active ingredient in many insect repellents, is considered safe, though it has been been linked with a small number of severe reactions. Choose a product with the lowest concentration of deet that proves effective for you. Reapply a repellent if you've been swimming or perspiring a lot or if the humidity is high.

But don't apply more than the label directs. Note: Repellents containing deet should not be used on children under age 2, and sparingly on children ages 2 through 6. Products containing more than 10 percent deet should not be used on children of any age.

In tests conducted by Consumer Reports, the most effective repellent for long days in the woods was a cream called Amway HourGuard12, now sold as 3M Ultrathon by the mail-order companies Travel Medicine and SCS Limited. Although it contains only 33 percent deet, its time-release formula kept ticks away for at least 9 hours at about $ 2 per use.

Repel Permanone with 0.5 percent permethrin is a good choice when spending lots of time in the brush. Spray it on your clothes (never your skin) and wait until it dries before putting the clothes on. In our tests, it kept ticks away for two weeks. A 6-ounce can cost $ 5.50. For shorter off-pavement excursions, consider BugOut, an aerosol, which worked for at least two hours against ticks and costs about a dime per use.

A bull's-eye-shaped rash is the hallmark of Lyme-disease infection and warrants prompt medical attention. The rash is absent in 15 percent of cases. So see your physician if you come down with other early symptoms-fever, stiff neck, body aches, or fatigue-after outdoor forays. Expect your doctor to take a thorough history (focusing on recent outdoor activities) and give you an exam. Blood tests can aid in the diagnosis, especially in the later stages of the disease. Early diagnosis followed by appropriate antibiotic treatment will cure most cases, according to recent studies.

Lyme Disease