The treatment of Lyme disease is long and difficult. Especially in the early stages of the infection, there is still the possibility to get the infection under control. In the advanced stages 2 and 3, in which first a distribution of the pathogen in the body and finally a chronification of the disease takes place, the effectiveness of a treatment is controversial.
Since Lyme borreliosis – a form of borreliosis that is widespread in Europe, especially in the northern hemisphere – is an infection with the bacterium Borrelia burgdorferi, antibiotic therapy is most promising in humans. The most common carrier of Lyme disease in Germany is the tick. Although mosquitoes and horseflies are also suspected of transmitting Borrelia burgdorferi, the rate of transmission is far from being as high.
After the bite by an infected tick, a so-called traveling rash, also called erythema migrans, forms within the incubation period of 2-4 weeks, which is a skin rash after the tick bite. This is considered to be evidence of a Borrelia infection, but unfortunately is often not recognized as such. Only in this early stage is the infection relatively easy to treat: The RKI (Robert Koch Institute) recommends treatment with tetracyclines such as Doxycyclin®.
Since Doxycyclin® is contra-induced in children and pregnant women, amoxicillin® or cefuroxime® is used. Tetracyclines are a group of antibiotics that prevent the synthesis of bacteria from bacterial DNA. They dock to the bacterial proteins that create proteins from the DNA and block their binding sites.
This leads to a blockage in the synthesis of the bacteria, and the supply of bacteria is cut off. The bacteria already produced are destroyed by the body’s own immune system. Antibiosis must be administered for 4 weeks in the early stages, and for treatment in the late stages for more than 4 weeks.
Prophylactic antibiotic administration after a tick bite is not recommended. Amoxicillin® and Cefuroxim® are used in children and pregnant women. Both inhibit the cross-linking of the bacterial wall components, so that the bacterial wall decays, without which the bacteria can no longer function.
Since allergies to individual antibiotics can also exist, the therapy has already been tried with many different antibiotics. In studies the therapy failure of individual antibiotics has been quantified in the range of 10-50%. This means that in 10-50% of patients the antibiotic used had no detectable effect and had to be switched to another antibiotic. This shows on the one hand how difficult therapy is in advanced stages, and on the other hand how important it is to start therapy as early as possible.
Costs
The costs for a Lyme disease treatment depend strongly on the stage of the disease. It seems logical that a 4 week antibiotic therapy is less cost-intensive than the treatment of a fulminant Borrelia infection in the late stage. While the costs for a 4-week antibiotic treatment are in the range of 50€, the costs for the care of a severely disabled patient with paralysis symptoms after neuroborreliosis are 100 times higher.
As the late consequences of a Borrelia infection for humans can be very diverse on the one hand and very severe on the other hand, it is important to start therapy as early as possible. However, a blood test by means of serology costs more than 100€, and is therefore not ordered as a lump sum. Much more there are a number of other diseases which are much more probable than Lyme disease, which can be disadvantageous for a Borrelia-infected person, as they are usually excluded first.
