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_http://www.sunherald.com/447/story/605710.html_

(http://www.sunherald.com/447/story/605710.html)

Perhaps we should be more familiar with AllMed Healthcare Mgmnt?

When Are Antibiotics for Lyme Disease Medically Necessary?

Guidelines downplay antibiotic treatment for longstanding symptoms

By AllMed Healthcare Management

PORTLAND, Ore., June 5 --

As good weather brings people outdoors and into the woods, it also exposes

them to tick bites that can result in Lyme disease, one of the fastest growing

infectious diseases in the United States. A microscopic bacterial organism,

Borrelia burgdorferi, carried by the Ixodes tick causes the Lyme infection.

Although the incidence of Lyme disease remains low -- about 100,000 cases each

year -- that's a big jump over the 16,000 cases the Center for Disease

Control (CDC) noted in 1999.

The CDC and Infectious Diseases Society of America (IDSA) have de-emphasized

antibiotics in the treatment of Lyme disease.

" The IDSA released guidelines that are more restrictive about using

antibiotics in the three stages of Lyme disease, " said Dr. Skip Freedman,

Executive

Medical Director at AllMed Healthcare Management, a leading independent review

organization.

According to Freedman, doctors should consider other diagnostic

possibilities first. Prior to diagnosing Lyme disease, they must verify that a

patient

has recently been in a place where the disease is epidemic -- usually the

coastal northeast, mid-Atlantic region, Wisconsin, Minnesota or northern

California. Then doctors should follow the current CDC and IDSA guidelines for

prescribing courses of antibiotic treatment.

During the first stage of the disease, infected patients may develop a

bull's-eye rash. In the second stage, they may show multiple skin lesions that

coincide with flu-like symptoms, followed by nonspecific muscular, skeletal,

arthritic, neuralgic, psychiatric and even cardiac symptoms.

" A diagnosis of Lyme disease should never be made based on initial blood

test screening alone, " Freedman said. Doctors must run more specific serologic

tests, including an enzyme-linked immunoassay and a Western blot test to check

if Lyme disease antibodies are present.

Once doctors determine that a patient is in stage one or two of the disease,

it can be easily treated with a two- to four-week course of oral

antibiotics. Most doctors prescribe doxycycline, (for adults and children over

eight

years old) or amoxicillin or cefuroxime (for adults and children under eight).

Usually -- but not always -- an early course of antibiotic treatment cures the

disease. Even with proper treatment, patients who have Lyme disease may

develop symptoms consistent with fibromyalgia or chronic fatigue syndrome. An

active infection, however, often isn't the source of such symptoms.

Doctors unfamiliar with Lyme disease often misdiagnose it as multiple

sclerosis, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome or

other

autoimmune and neurological diseases. Misdiagnosis, as well as delayed or

inadequate treatment, may lead to the persistent third stage of the disease.

Without early and medically necessary antibiotic treatment, 10 to 15 percent

of Lyme disease patients may display arthritic or even neurological

complaints. And 80 percent of patients with Lyme disease develop malaise and

fatigue

similar to chronic fatigue syndrome. They also may display other symptoms

unrelated to Lyme disease.

The current recommendations for diagnosis and care require either the

bull's-eye rash or positive specific laboratory tests and only recognize false

negatives during the early stages of the disease. The recommendations also

suggest that post-Lyme disease syndromes don't respond to long-term antibiotic

use.

For more information on leading-edge treatments and their medical necessity,

check out

http://www.allmedmd.com/peerpoints/cuttingedge/cutting_edge_email.htm. To find

out more about the services that independent review organizations

offer, go to AllMed's Website at http://www.allmedmd.com.

SOURCE AllMed Healthcare Management

Middlewood, +1-360-882-1164, martinm@..., for AllMed

Healthcare Management

Coughlan

Presaident

MA Lyme Disease Awareness Assoc.

Mashpee, MA

**************Vote for your city's best dining and nightlife. City's Best

2008. (http://citysbest.aol.com?ncid=aolacg00050000000102)

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