I agree that there seems to be different definitions being used. This is what I use when talking about
these infections. Taken from Burrascano's (ILADS) treatment recommendations, pages 19 & 20:
www.ilads.org/lyme/B_guidelines_12_17_08.pdf"TICK BITES - Embedded Deer Tick With No Signs or Symptoms of Lyme (see appendix):
Decide to treat based on the type of tick, whether it came from an endemic area, how it was removed,
and length of attachment (anecdotally, as little as four hours of attachment can transmit pathogens). The risk
of transmission is greater if the tick is engorged, or of it was removed improperly allowing the tick's contents to spill into the bite wound. High-risk bites are treated as follows (remember the possibility of co-infection!):
1) Adults: Oral therapy for 28 days.
2) Pregnancy: Amoxicillin 1000 mg q6h for 6 weeks. Test for Babesia, Bartonella and Ehrlichia.
Alternative: Cefuroxime axetil 1000 mg q12h for 6 weeks.
3) Young Children: Oral therapy for 28 days.
EARLY LOCALIZED - Single erythema migrans with no constitutional symptoms:
1) Adults: oral therapy- must continue until symptom and sign free for at least one month,
with a 6 week minimum.
2) Pregnancy: 1st and 2nd trimesters: I.V. X 30 days then oral X 6 weeks
3rd trimester: Oral therapy X 6+ weeks as above.
Any trimester- test for Babesia and Ehrlichia
3) Children: oral therapy for 6+ weeks.
DISSEMINATED DISEASE - Multiple lesions, constitutional symptoms, lymphadenopathy, or any other manifestations of dissemination.
EARLY DISSEMINATED: Milder symptoms present for less than one year and not complicated by immune
deficiency or prior steroid treatment:
1) Adults: oral therapy until no active disease for 4 to 8 weeks (4-6 months typical)
2) Pregnancy: As in localized disease, but treat throughout pregnancy.
3) Children: Oral therapy with duration based upon clinical response.
PARENTERAL ALTERNATIVES for more ill patients and those unresponsive to or intolerant of oral
medications:
1) Adults and children: I.V. therapy until clearly improved, with a 6 week minimum. Follow with oral
therapy or IM benzathine penicillin until no active disease for 6-8 weeks. I.V. may have to be
resumed if oral or IM therapy fails.
2) Pregnancy: IV then oral therapy as above.
LATE DISSEMINATED: present greater than one year, more severely ill patients, and those with prior
significant steroid therapy or any other cause of impaired immunity:
1) Adults and pregnancy: extended I.V. therapy (14 or more weeks), then
oral or IM, if effective, to same endpoint. Combination therapy with at least
two dissimilar antibiotics almost always needed.
2) Children: IV therapy for 6 or more weeks, then oral or IM follow up as above. Combination
therapy usually needed.
CHRONIC LYME DISEASE (PERSISTENT/RECURRENT INFECTION)
By definition, this category consists of patients with active infection, of a more prolonged duration, who are
more likely have higher spirochete loads, weaker defense mechanisms, possibly more virulent or resistant
strains, and probably are significantly co-infected. Neurotoxins may also be significant in these patients.
Search for and treat for all of these, and search for concurrent infections including viruses, chlamydias, and
mycoplasmas. Be sure to do an endocrine workup if indicated. These patients require a full evaluation for all of
these problems, and each abnormality must be addressed.
The only caveat that I would add is that Chronic Lyme can happen much more quickly for some.