For those who don't know who Paul Auwaerter is:
From IDSA website (
www.idsociety.org/lyme/)
"Chronic Lyme Disease Video-
IDSA's Dr. Paul Auwaerter describes the issues with the chronic Lyme disease diagnosis, including the dangers of misdiagnosis and prolonged use of antibiotics."
www.idsociety.org/Updated_Guidelines_on_Diagnosis_Treatment_of_Lyme_Disease/"Most people who are infected with Lyme disease have a circular, red rash surrounding the site of a tick bite, that may be accompanied by muscle and joint aches and less commonly, facial paralysis,” said Lyme disease expert Paul Auwaerter, M.D., M.B.A., who was a reviewer of the IDSA guidelines. Dr. Auwaerter is the Clinical Director of the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, and managing editor of the Johns Hopkins Antibiotic Guide."
canlyme.com/2014/11/10/the-mayday-project-responds-to-dr-paul-auwaerters-defense-of-idsa-guidelines-for-lyme-disease/"However, we take issue with Auwaerter’s statement that “the recommendations in IDSA’s guidelines are safe, effective…”"
"Dr. Auwaerter’s statement that “IDSA considers all relevant scientific information when developing its guidelines” is also misleading."
In an article in the Huffington Post, dated October 2013 (
chrissmith.house.gov/news/documentsingle.aspx?Documentid=352107):
""The current IDSA guidelines provide the best scientific, evidence-based medical practices for the treatment of Lyme disease including early and late forms." -- Dr. Paul Auwaerter"
When asked about
the increase in recognized cases of Lyme, by the CDC (when it raised to 300,000), Auwaerter said:
"This study gives an estimate of annual cases. Historically, any "reported" infection to the CDC has been typically only 10% of actual, so this study comports with those for venereal diseases, food borne infections, etc. That said, Lyme disease has increased in numbers over the past decade and is slowly spreading regionally from initial focus in Upper Midwest and coastal/riparian New England. Regardless of the number of cases, the current IDSA guidelines provide the best scientific, evidence-based medical practices for the treatment of Lyme disease including early and late forms."
"Dr. Auwaerter: Do the guidelines allow for antibiotic treatment in the event of typical Lyme disease symptoms without either of the EM rash or positive Western blot test?
I am not sure what you mean, but Lyme disease should be treated if someone has acute symptoms and the typical rash. In patients who are acutely ill and have fever, this is non-specific, but we often treat empirically with doxycycline for tick-borne infections if patients have a risk of acquisition.
Your answer for patients with long-term symptoms (not acute) would be no, we need to see laboratory evidence of infection in patients with problems that could be attributable to Lyme disease."
Dr. Auwaerter: If victims do not have chronic Lyme how do you explain the ongoing symptoms in patients who remain ill long after they have been treated?
Chronic Lyme disease is an indistinct term. I prefer to use terms such as late Lyme disease (for example with an active infection needing antibiotics such as a swollen knee arthritis due to B. burgdorferi) or post-treatment Lyme disease syndrome for those symptoms that persist after antibiotics that often resemble fibromyalgia, or chronic fatigue. The post-infectious syndrome cause is not known and hence why we use the term syndrome. It is more common in women and in those who have had untreated infection for longer periods of time.
Dr. Auwaerter: There are a number of newer studies (animal models and human models) that indicate the Lyme bacteria can hide in protective structures from antibiotics. Can you comment on this research?
There are no high quality human studies to back up this comment. For animal models, other than occasional antibiotic treatment failure, what most of these animal studies have found is evidence by PCR methodology of DNA for B. burgdorferi - but not cultivable, viable bacteria. The significance of this is unclear, and many bacterial and viral infections have evidence of DNA debris in both animals and humans that persist after resolution of infection.
"...It's without any solid merit that advocates of long-term therapy have provided any evidence their patients do better than placebo."
"Dr. Auwaerter: Doctors around the world claim they are seeing more patients with co-infections. Might this be the reason why patients with Lyme disease continue to feel unwell?
Authentic co-infection is rare. Over the last 15 years, I have never verified a co-infection (Babesia, Ehrlichia, RMSF, Bartonella) that was diagnosed by so-called Lyme experts (LLMD). Co-infection, much like Lyme disease, is over diagnosed as an explanation for chronic symptoms of fatigue, un-wellness."
So, you see, it's extremely difficult for me to believe he has suddenly switched sides.
And for those that aren't quite convinced yet, take a look at this: IDSA Lecture
Paul G. Auwaerter -
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Author Affiliations
Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
Point: Antibiotic Therapy Is Not the Answer for Patients with Persisting Symptoms Attributable to Lyme Disease
cid.oxfordjournals.org/content/45/2/143.full