[Lyme borreliosis: therapeutic aspects]

CAUSAL AGENTS: Several Borrelia burgdorferi sensu lato species have been recently described which cause different clinical forms of Lyme disease. B. garinii is implicated in neurological forms, B. burgdorferi sensu stricto in articular forms and B. afzelii in late cutaneous forms. As such disease diversity is seen only in Europe and Asia, clinical management in Europe is somewhat different than in North America. NUMEROUS CLINICAL TRIALS: A recently proposed classification of the European forms of Lyme disease is based on clinical presentation: contagious conditions or erythema migrans, early neurologic or cardiologic complications, late articular, neurologic or cutaneous complications. Therapeutic proposals should be guided by the results of European trials, taking into account this classification.

For contagious conditions or erythema migrans, amoxicillin and doxycycline are the first intention antibiotics and should be given for 14 to 21 days. Other antibiotic classes (macrolides, oral cephalosporins) have not been found be more effective and should be reserved for second line treatment. Early neurological involvement requires penicillin, a third generation cephalosporin or doxycycline for one month. Oral antibiotics are preferred in case of joint involvement using amoxicillin or doxycycline as first line therapy. A second regimen could be proposed in case of failure. Parenteral administration should be reserved for second line treatment. There is little data available on chronic atrophic acrodermatitis and protocols are based on ceftriaxone, doxycycline or penicillin.