Är behandling med doxycyklin motiverat vid borreliainfektion?

Sammanfattning: Background: Every year approximately 5 000-10 000 persons in Sweden are diagnosed for Lyme disease. In Europe the incidence is about 65 000 persons per year. Lyme disease is a tick-borne zoonosis, the causative agents – Borrelia burgdorferi-genospecies - are transmitted by Ixodes-ticks (in Sweden primary I.ricinus). Lyme disease is treated with antibiotic-therapy. Though, in 5-15 percent of the cases, post-treatment symptoms can appear and persist for six months, or longer. Today we don´t know the origin of the phenomena. Some patients seek help outside the Swedish borders, and turn to so called Lyme disease-clinics – which, in some cases, institutes long-term antibiotic-treatment. The pharmacist may encounter this particular matter, while carrying out EES-antibiotic-prescriptions, prescribed non-analogous to Swedish guidelines.  Objective: The aim of this study was to investigate the efficacy of doxycycline, with respect to short-, middle-, and long-term Lyme disease-treatment. The intention was also to investigate the pharmacist role in executing EES-antibiotic-prescriptions.  Methods: The study was divided into two parts. The first part was investigating doxycycline, and was based on five scientific articles collected from PubMed. The second part was a review of the pharmacist role in processing EES-antibiotic-prescriptions; information was collected by email correspondence with pharmacy chain stores, authorities and federation of labor unions.  Results: Awareness and protective measures regarding ticks and Lyme disease seems dire. Improved diagnostic methods, uniform interpretation of outcome, standardized laboratory-analysis is of paramount importance. The pharmacist concerns with EES-antibiotic-prescriptions is carrying out the medical prescription and giving medical advice. Doxycycline in 10-14 days Lyme disease-treatment was seen as an alternative, supported by Swedish guidelines. The post-exposure prophylaxis was not a recommended alternative. Regarding doxycycline and long-term Lyme-disease-treatment, it was postulated that additional scientific studies was needed. Conclusions: The tick, vector of Borrelia burgdorferi, will be favoured of recent and upcoming climate changes. In the future to come, we can expect an expansion of the tick-habitats and with it follows the probability of more frequent encounters with the human race. This will most likely contribute to a higher incidence of Lyme disease. Prevention and subject-enlightenment is of need. The pharmacist will in the professional role be exposed to daily moral dilemmas; one of these dilemmas can be the execution of EES-antibiotic-prescriptions, not prescribed accordingly to Swedish guidelines, with respect to Lyme disease. As things stand today, the primary commitment will be medical advice and carrying out the prescription. The post-exposure prophylaxis regarding doxycycline and Lyme disease is not recommended. The 10-14 days doxycycline-cure, regarding some Lyme disease-manifestations, is mostly a preferable alternative today. Prolonged antibiotic-treatment with doxycycline, in respect to post-treatment symptoms, needs to be further evaluated with better diagnostic methods, scientific studies, standardized analysis and more uniform interpretation of results.