DOXYCYCLINE DOSE FOR SUSPECTED LYME NEUROBORRELIOSIS

Penetration of doxycycline into cerebrospinal fluid in patients treated for suspected Lyme neuroborreliosis.

1. L Dotevall and 
2. L Hagberg

3. 1. ABSTRACT

      Twelve patients were treated orally with 100 mg of doxycycline twice a day (b.i.d.) and 10 patients were treated with 200 mg b.i.d. for suspected tick-borne neuroborreliosis (Lyme borreliosis). At 5 to 8 days after the start of therapy, the mean concentrations in serum were 4.7 micrograms/ml for the doxycycline dose of 100 mg b.i.d. and 7.5 micrograms/ml for 200 mg b.i.d., 2 to 3 h after the last drug administration. The corresponding levels for cerebrospinal fluid were 0.6 and 1.1 micrograms/ml. Since a doxycycline concentration in cerebrospinal fluid above the estimated MIC for Borrelia burgdorferi (0.6 to 0.7 microgram/ml) is wanted in patients treated for severe neuroborreliosis, the higher dose is preferable.
   2. http://aac.asm.org/content/33/7/1078.abstract?ijkey=32ae649d2891cc7a457c8e2fa29caeea04a73581&keytype2=tf_ipsecsha

   3. Minocycline versus Doxycycline in the Treatment of Lyme Neuroborreliosis

   4. 
      
   5. 'It is not commonly appreciated that ill patients treated with doxycycline (e.g., patients with legionnaires' disease) should be given a loading regimen of 200 mg iv q12h for the first 72 h, because of doxycycline's lipid solubility characteristics and long half-life. Since 5 serum half-lives are usually required to achieve steady-state serum concentrations, and early therapeutic effect, a loding regimen rather than a loading dose permits rapid saturation of the serum. If doxycycline is administered in the usual dosage of 100 mg q12h, then it takes 4–5 days to achieve steady-state kinetics and an observable therapeutic response. In Lyme neuroborreliosis, rapid saturation of the CNS compartment is key to the efficacy of short-course regimens (≤14 days). Doxy-cycline is usually given in dosages of 100 mg q12h, which means that the first week of treatment is virtually lost in achieving steady-state equilibrium, and equilibrium results require 3 weeks [7–10]. Dotevall and Hagberg correctly used 400 mg of doxycycline daily and decreased treatment time to ∼10.8 days.'
   6. http://cid.oxfordjournals.org/content/30/1/237.2.full
   7. 
      
   8. Although the above articles were published some years ago I have posted them because they support the need for a higher dose of Doxycycline in the treatment of early Lyme Neuroborreliosis. A concept foreign to most of our doctors. Lyme Neuroborreliosis is when the bacteria affect the nervous system and the symptoms are many and varied the best resource for details about Lyme Neuroborreliosis is found in the leaflet Lyme Disease Action have on the subject. It is easy for patients and doctors to say it is suspected Lyme Disease and fail to realise the significance of nervous system symptoms indicating Lyme Neuroborreliosis.
   9. http://www.lymediseaseaction.org.uk/wp-content/uploads/2013/05/LDA003-2-web-version.pdf
   10.