Physicians in the tristate area need no advice on diagnosis and treatment of early-stage
Lyme disease. Advanced and therapy-resistant Lyme disease, however – with arthritis,
neurological involvement and cardiac complications – are more worrisome challenges that raise
questions about intravenous antibiotic treatment, controversial long-term oral therapies and the
need for specialty support care.
Long-Term Oral Therapy Not Effective
“The scientific community has looked at long-term
therapy for Lyme disease, and there is no evidence
that antibiotic therapy for more than four weeks
is indicated,” says Nathan Litman, MD, director,
Pediatric Infectious Disease, The Children’s Hospital
at Montefiore (CHAM).
Patients with symptoms of arthritis that persist
after initial oral therapy may benefit from “a second,
different oral antibiotic,” says Dr. Litman, “and, if they
have another episode, may be treated with an intravenous
antibiotic.” Patients with meningitis and some with heart
blockage should be treated with intravenous antibiotics.
MultiModality Care for Patients
With
Late-Stage Lyme Disease
If late-stage Lyme disease symptoms persist after
adequate therapy, children should be swiftly referred
to specialty care, ideally at a facility comprehensively
staffed by pediatric multidisciplinary specialists.
Among Lyme disease’s relatively rare complications
is severe arthritis that may become “an immunologic,
self-perpetuating disease,” says Norman Ilowite, MD,
chief, Pediatric Rheumatology, CHAM. The condition
“can improve with intra-articular steroids” administered
by a pediatric rheumatologist, if appropriate antibiotic
therapy fails, says Dr. Ilowite, and failing this, CHAM
pediatric orthopedic surgeons can perform a synovectomy
to remove inflamed joint tissue.
At-Home IV Treatment and One-Stop
Therapeutic Services
At CHAM, services are customized with families in
mind. Patients who need IV therapy can receive a
percutaneous intravascular catheter (PIC) that allows
them to “get their daily therapy at home” and avoid
school absences, notes Dr. Litman.
And CHAM provides the convenience of under-oneroof
treatment that allows a sick child to – in a single
visit, if needed – see our experts in rheumatology,
infectious disease, cardiology, hematology, neurosurgery
and “the entire array of specialists required to treat any
pediatric Lyme disease issue,” says Dr. Litman.
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