Life After Lyme Disease

There are a number of natural supplements available that can be used to treat Lyme disease.  Many of these work by supporting the immune system and helping your body to heal itself. For example amino acid supplements (containing creatine) have been shown to ease joint and muscle pain caused by chronic Lyme disease.  Omega-3 essential fatty acids (EFAs) have also been found to ease fatigue and neurological problems associated with this infectious condition.

Ginseng

Ginseng is mostly used in the west as an energy boosting supplement, but in reality it is a very complex natural substance that can have a number of beneficial effects on the body.  Ginseng is the most versatile herb in Traditional Chinese Medicine and there are several varieties including Panax ginseng (which is the Chinese version) and Siberian ginseng (Eleutherococcus senticosus).

Ginseng root supplement

Ginseng is what is known as an adaptogen.  This means that once it is in the body it will adapt in a number of different ways depending on the conditions.  This is why ginseng is so versatile as it can help to treat a very wide range of symptoms from depression through to hormone imbalances. 

Side Effects

Ginseng is a powerful herb and its main strength lies in its ability to stimulate the body’s own natural systems.  This does mean that if you take too much ginseng you could over stimulate your body and cause side effects such as palpations, sweating, nausea and headaches. These should disappear once you stop taking ginseng but if they persist you could have an underlying condition that needs to be checked out by a healthcare advisor.

Ginseng and Lyme Disease

Lyme disease is a widespread infection which can cause a number of different symptoms including fatigue, headaches and joint pain.  If left untreated this infection can spread into the vital organs and cause a number of serious symptoms including impaired mental function and problems with the central nervous system.  Ginseng can be used in conjunction with other treatments to help defend the body against this widespread infection.  Ginseng has the ability to support brain health and improve mental function.  It also provides a boost to energy and stamina and this can help to combat the fatigue often linked with Lyme disease.  One of the main ways in which ginseng can help to fight Lyme disease is by boosting the immune system.  This can help the body to fight the infection naturally and this has been shown to help sufferers to eradicate this infection for good. 

Ginseng can also help to boost overall health by supporting the liver, thyroid and adrenal glands and ensuring the healthy, natural balance of blood pressure, blood sugar levels and hormones.

Taking Ginseng

Ginseng is widely available and is typically taken in capsule or liquid form of around 250 to 500mg per day.  You can also buy ginseng root fresh or dried from some specialist suppliers.  To use this root steep ½ teaspoon in a cup of hot water and drink as a refreshing tea once or twice a day.  Try to avoid taking too much ginseng as this is a stimulating herb and can cause diarrhoea, indigestion and headaches if taking in large quantities.

Homeopathy Supplements

Homeopathy can be used to treat a wide range of chronic conditions.  This holistic treatment has been shown to have positive effects on widespread infections including Lyme disease.

The Centers for Disease Control (CDC) has warned that Lyme disease is the fastest growing vector-borne disease in North America.  The majority of Lyme disease cases are located in just 12 high risk areas which include Connecticut, New York, Pennsylvania and Maine.  The only state that has not seen any reports of Lyme disease in North America is Montana.

Homeopathic Diagnosis

Homeopathic practitioners endeavor to create a full picture of a patient’s health.  This will encompass diet, lifestyle and general feelings of well being.  Both conventional and holistic healthcare advisors face a number of difficulties when diagnosing Lyme disease.  The symptoms can be vague and in many cases patients do not realize they may have been exposed to the ticks that carry the Lyme infection.  There are also no reliable scientific testing procedures in place for confirming Lyme disease. This can lead to many cases of incorrect diagnosis, both in terms of over and under diagnosis of Lyme disease.

The main benefit of the homeopathic treatment process is that it does not rely on the confirming the presence of Lyme disease absolutely.  Instead this method presents an initial diagnosis and then records how the condition has manifested in the individual patient.   By charting the history of illness the homeopathic practitioner can understand how the disease is affecting the body and how to tackle the symptoms appropriately.  Conventional medicine recommends only one treatment scheme (a short term course of antibiotics) to treat all Lyme patient sufferers, regardless of symptoms.  Homeopathic treatments however are highly personalized and can show some positive effects within just a few days.

Treatment

Unlike the conventional medical community Homeopathic practitioners remain united over the treatment of Lyme disease.  This unified front shows an inspiring faith in the healing system which cannot fail to impress patients. Once the individual manifestation of the condition has been identified then the practitioner will rely on accepted treatment methods to manage symptoms and work towards a cure.  Many of these treatments will work to support and boost the immune system and strengthen the patients own natural defenses against the Lyme infection.  Conventional medical experts are also beginning to see the benefits of assisting the immune system to fight widespread infections naturally.  Each homeopathic treatment will be slightly different but typically treatments used to combat this condition including Sepia, Sulphur, Tellurium, Syphilynum, Ledum, Carcinocin, Arnica, Rhus Tx, Arsenicum, Apis, Hypericum, Ruta and Silica.  There are also a wide number of other homeopathic treatments that can be used with success against Lyme disease.

Hypericum can be used to treat Lyme Disease

As well as homeopathic supplement treatments homeopathic practitioners can recommend a number of other treatments to work on overall health and well being.  These can include herbal supplements, diet, heat therapies (raising the body temperature to inhibit bacterial growth) and stress reduction techniques.

Homeopathic treatments work on overall health and well being.  They tackle not just the condition itself but also any weaknesses in the body’s system that could be contributing to ill health.  Many Lyme disease patients have responded well to homeopathic treatments and this could be worth investigating if you are not happy with conventional treatments.

Lyme disease is one of the fastest spreading conditions in North America and scientists are constantly working on new treatments and detection procedures.  One of the main problems surrounding Lyme disease it that it can be difficult to detect with the current blood test procedure recommended by the Centers for Disease Control and Prevention.  This is because the Borrelia burgdorferi bacteria that causes the condition can take weeks or even months to develop to a visible level. 

Blood testing

Early detection of Lyme disease is key in the successful treatment of this condition, so scientists are keen to implement a more effective test procedure. Lyme disease is transmitted to humans and animals by the bites of infected blacklegged ticks.  This disease can cause a number of symptoms from fatigue and nausea through to more serious rheumatological, neurological and cardiac complications.

Lyme Symptoms

Lyme disease can be difficult to diagnose on testing alone so it is important that both patients and doctors understand symptoms.  If you have been exposed to ticks and start to feel unwell you should visit your healthcare advisor as soon as possible.  Symptoms can include feelings of tiredness, nausea, muscle weakness and constant headaches.  You should also look out for the characteristic ‘bulls eye’ rash which often appears in conjunction with Lyme disease.  This rash can appear anywhere between three days to four weeks after the initial infection.  Commonly the rash manifests initially around the original infection site.  Lyme disease can remain dormant in the body for some time before any symptoms start to show.  This means that the patient may not remember having been exposed to ticks.  This is why it is so important that healthcare advisors have access to an accurate method of testing to identify this disease for treatment.

Luciferase Immunoprecipitation System (LIPS)

The luciferase immunoprecipitation system (LIPS) test has been around for a few years now and has been used to detect a number of viral and fungal pathogens that can affect the body.  Researchers at the National Institutes of Health have recently announced successful results in the using the LIPS test for Lyme disease.  These results were reported in the recent June 2010 edition of the respected journal ‘Clinical and Vaccine Immunology’. 

In the latest research from the National Institutes of Health the LIPS test was evaluated for its effective at detecting antibody responses to Lyme bacteria.  Blood tests were taken from infected patients and also those that had not been exposed to Lyme disease.  Researchers found that 98 to 100% of patients were correctly diagnosed as having Lyme disease through using the LIPS test in combination with the synthetic protein VOVO.  The report suggested that :

‘…screening by the LIPS test with VOVO and other B. burgdorferi antigens offers an efficient quantitative approach for evaluation of the antibody responses in patients with Lyme disease.’

These results are very impressive and the rollout of screening for Lyme disease through LIPS test with VOVO could offer an effective way to diagnose Lyme Disease quickly and effectively in the future.

The Marshall Protocol was first developed by the biomedical researcher Trevor Marshall, Ph.D. It can be used treat chronic inflammatory and autoimmune conditions such as Lyme disease. This has been described as a ‘curative’ treatment that aims to tackle the root cause of the infection, rather than just cover up the symptoms.

Benicar is used in the Marshall Protocol Treatment Plan

Challenges Facing Sufferers

The problem with Lyme disease is that it can go undetected for a long period of time. This is because many of the symptoms are generalised and difficult to diagnose. This allows the Lyme bacteria (Borrelia burgdorferi) to spread throughout the body causing widespread infection. This bacteria has also been shown to ‘disguise’ itself and can hide in the body and evade drugs used to eradicated this form of infection. This means that chronic Lyme disease can be very resistant to standard treatments. This includes short term antibiotics which are commonly prescribed for Lyme disease and many sufferers experience months and even years of pain and discomfort whilst they try to overcome the condition

A New Approach to Treating Chronic Lyme Disease

The Marshall Protocol has been developed to tackle chronic, wide spread infections such as Lyme disease. Patients are given a type of medication known as olmesartan (also called Benicar), which boosts the immune system and increases the production of anti-microbial peptides. These peptides have been shown to be crucial in eradicating widespread pathogens and can tackle multi-infections at the same time. This is highly beneficial for Lyme disease sufferers as a large percentage have co-infections that can impede the healing process. Simultaneously to this treatment patients are also prescribed low-dose, pulsed antibiotics. This method of taking antibiotics is known to be much more effective at treating bacteria that can hide from standard treatments. These antibiotics work to weaken the bacteria by preventing them from producing the proteins they need to survive and also reproduce.

Once the bacteria start to die they release toxins into the bloodstream and this can result in a change in immunopathology, which is known as the ‘Herx’ reaction. This creates a number of symptoms in the body including a temporary hormonal imbalance and the stimulation of inflammatory cytokines. This means that the patient will see an escalation in the severity of symptoms for a few weeks or months, before their immune system can return to a more natural balance. Many patients find this increase in symptoms alarming, but the Herx reaction is very common and treatments can be adjusted to balance immunopathology. In severe cases of chronic Lyme disease it can take several years to complete the Marshall Protocol treatment. However patients will begin to see health improving gradually as the infection starts to lessen its hold on the body. In most cases a state of total remission can be achieved.

Blood sample ready for testing

Can the Marshall Protocol Work For You?

One of the easiest ways to find out if the Marshall Protocol could be used to treat your condition is to get a blood test. This will identify whether you to have an elevated level of D metabolites, which is an indicator of chronic infection. A therapeutic probe should also be carried out which will monitor the patients during the stages of treatment to see whether any changes in immunopathology result from taking the Marshall Protocol medicines.

Lyme disease is a complex bacterial infection which can spread throughout the body causing a number of different symptoms. It is transmitted by the bite of blacklegged ticks and is prevalent throughout Europe and parts of America.  The Borrelia bacteria which cause the  infection can trigger inflammation in many different parts of the body including vital systems, organs and tissues.  This is one of the reasons why Lyme disease can be such a debilitating condition with wide ranging symptoms.

Black legged tick

Dealing with widespread infection can be difficult and this is why Lyme disease can be a complex condition to manage.  At the heart of any Lyme disease treatment is the necessity to eradicate the Borrelia bacteria which is causing the infection and inflammation.  The recommended treatment is currently a three to four week course of an oral antibiotic such as doxycycline or amoxicillin (a penicillin based treatment).  Studies have shown that a minimum 10 day regime of one of these antibiotics was enough in most cases to successfully clear up the main infection.  However this is only effective on cases of initial Lyme disease infection.  Once the bacteria has had a chance to spread throughout the system it can be much more difficult to deliver the antibiotics to the infection sites.  Intravenous ceftriaxone may be prescribed if there are any signs of infection or inflammation in major systems such as the central nervous system or brain. 

Treating Inflammation

Even during the successful treatment of Lyme disease inflammation can persist for weeks and in some cases can get much worse before it gets better.  This is why it is important not just to treat the main cause of the infection but also the side effects.  Inflammation resulting from Lyme disease can be painful and can also cause debilitating problems such as Lyme arthritis.  This is when the bacteria invades the joints causing severe inflammation and swelling, particularly in the knees.  There are a number of ways in which you can manage the symptoms of inflammation in cases of Lyme disease.  Many patients suffering from Lyme disease inflammation can respond well to holistic treatments and a change in diet.

Diet

A low-carb, low sugar diet has been shown to be effective at reducing internal inflammation in a wide range of conditions.  This is because the high levels of sugar and starch found in most modern diets can actually promote inflammation as they encourage the growth of bacteria and yeast.  These microbes cause inflammation because they excrete acids and toxins when they feed on complex sugars.  By cutting down on sugar and starch in your diet you can help to ‘starve’ these microbes and reduce the amount of toxins they produce, therefore reducing swelling.

Dietary Supplements

There are several supplements available which have been shown to be effective at reducing inflammation.  These include:

• Methylsulfonylmenthane (MSM) – this supplement needs to be taken in quite high dosages to be effective, but it is one of the safer dietary supplements.  It is well known for reducing inflammation and can be used to treat Lyme disease symptoms.
  

  Cats Claw

• Green Tea – you can take green tea in supplement form or drink it as a herbal tea.  It has been used for hundreds of years to treat internal infections successfully and recent studies have shown it can inhibit the growth of bacteria and yeast in the body, reducing inflammation.
• Salmon Oil – salmon oil is very high in Omega-3 fatty acids.  In particular it contains the fatty acids EPA and DHA, which have been found to reduce inflammation.
• Cats Claw – this supplement has been shown to significantly inhibit bacteria growth and reduce inflammation.
• Vitamin C - this is a common supplement and recent studies have revealed the powerful effects this can have in supporting healing systems in overcoming system wide infections.

Lyme disease is a prevalent modern disease and is difficult to treat because the symptoms can be very generalised, which can lead to problems with misdiagnose. Lyme disease is caused by the Borrelia burgdorferi bacteria and this presents another set of difficulties when it comes to treatment as this is a spiral-shaped bacterium that can mutate and hide in the body, rendering traditional short-term antibiotic treatments ineffective.

Experts are continually looking into new forms of treatment for virulent infections diseases such as Lyme disease and a number of new anti-microbial therapies have been discovered which can have some beneficial effects.

Spiral-shaped Borrelia burgdorferi

Hyperthermia

Many types of bacteria such as Borrelia burgdorferi can only survive in certain temperatures. Perfect environments are provided by warm blooded mammals and this is one of the reasons why this bacterium thrives so well in the human body. Tests have revealed that using heat treatments can increase the effectiveness of short-term antibiotic treatments. Raising the body temperature using hot showers or baths for 20-30 minutes every day has been shown to weaken the Borrelia burgdorferi bacteria and make it more susceptible to eradication by antibiotics. An additional benefit of raising body temperature is that it causes the peripheral circulation to dilate and this increases the absorption of drugs such as antibiotics in the body, allowing it to penetrate deep tissue and ensure that drugs can reach all the infected areas. Hyperthermia treatments are thought to increase the effectiveness of antibiotic therapy against infectious diseases such as Lyme disease by as much as 16 times.

Rife Machine

Rife machines emit different frequencies of energy that can penetrate deep into the tissues of the body and cause the spiral-shaped Borrelia bacterium to resonate. This can be so disruptive to the Borrelia that it can actually damage the integrity of the cells and weaken the bacteria so that it cannot reproduce. Rife machines can also kill harmful microbes outright and this is an effective method for eradicating problem infections such as Lyme disease that can be resistant to antibiotic treatments. Rife machines do have a very similar effect to microwaves, although the energy levels emitted are not harmful. These machines have not yet been approved by the FDA and are also quite expensive (around $1,000 each) and this is the main reason why Rife machines are not more widespread for the treatment of Lyme disease.

Beck Electrification

This is another machine that is used to disrupt the integrity of harmful microbes such as Borrelia, causing them to weaken and die. This machine emits low voltage electricity waves and as well as eradicating microbes has also been shown to improve antibiotic absorption in the body increasing the effective of this treatment to eradiate Lyme disease.

Side Effects

Although anti-microbial treatments can be successful at eradicating Lyme disease they can cause a number of side effects including the Jarisch-Herxheimer reaction (herx) reaction. This occurs several days after treatment and causes symptoms to increase significantly. This can last for as long as two weeks into the treatment regime and has to be monitored carefully to avoid any unnecessary suffering for the patient.

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Vitamin C is one of the most commonly used supplements in the world and many people regularly take oral vitamin C pills to boost overall health and ward off viruses and bacterial infections. There is a wealth of medical evidence available which has documented the ability of vitamin C to cure a number of infectious diseases, including Lyme disease.

Medical experts are very interested in the powerful healing effects of vitamin C and many believe this supplement could be one of the most effective weapons we have against viral syndromes, even those that can be incurable with modern medicines.

Why is vitamin C not prescribed for Lyme disease?

Despite the potential for vitamin C to help Lyme disease sufferers some clinical failures have been recorded which have prevented medical authorities from considering this supplement in mainstream healthcare. However after reviewing the huge volume of medical evidence relating to vitamin C several leading experts concluded that there were some clear reasons for the clinical failures of vitamin C and that they appeared to occur only when ‘a large enough amount of vitamin C cannot be effectively delivered to the invading microorganisms.’ (Stone, 1972; Smith, 1988, Levy, 2002).

These conclusions where based on the necessity of delivering vitamin C in very high dosages directly to the main sight of the infection. Oral supplements were simply not effective enough at delivering the right quantities of vitamin C into the site of infection to combat the high concentrations of invading microorganism.

Tests on the clinical effectiveness of vitamin C showed that the majority of clinical failures resulted because of inadequate delivery methods (Casciari et al. 2001). Even administrating high dosages of vitamin C (as much as 60,000mg) using intravenous injections was not always successful This means that in order for vitamin C to be recommended as a standard treatment for infectious conditions such as Lyme disease the method of delivery has to be improved.

New techniques for vitamin C treatment

New techniques for delivering vitamin C have been developed and at the Colorado Integrative Medical Center (www.coloradomedicalcenter.com) medical staff have begun using a new form of vitamin C therapy. This is known as Pulsed Intravenous Vitamin C (PIVC) therapy and offers the ability to administrator a very rapid and intensive delivery of vitamin C to the body. PIVC works by getting blood levels of vitamin C as high as possible by administrating rapid dosages in order to deliver the maximum healing power to the site of infection. This method has been shown to be safe and effective at treating a number of different conditions.

The rapid administration of high levels of vitamin C can also induce side effects such as acute hypoglycemia. This can boost healing as acute hypoglycemia is well documented at assisting the absorption of drugs into specific areas of the body and this is known as Insulin Potentiation Therapy (www.iptq.org). This is essential for vitamin C treatment because glucose can compete with vitamin C for transport around the body. By lowering the glucose levels in the blood you can ensure that higher dosages of vitamin C are transported to the site of infection.

The future of vitamin C therapy for treatment of conditions such as Lyme disease is uncertain, but the positive results being documented from new techniques such as PIVC will go a long way to convincing health authorities that this can be a safe and effective treatment for infection conditions.

Supplements can be used to support healing and promote normal function in the body. Researchers have been extensively testing key supplements such as vitamin C and D in recent years to try and understand in what ways these natural healthcare options can affect our bodies and how they can be used to boost healing. The results of these findings have played an important part of formulating new treatment plans for chronic and difficult to manage conditions such as Lyme disease and other persistent bacterial infections.

Vitamin C

Vitamin C has been shown to help support natural health in the body and dosages of around 1000mg/day can help to ward off bacterial infections such as the common cold. Extensive research has been carried out on this supplement to identify the exact healing affects it can have on the body and scientists have discovered some very interesting results. For example a recent clinical trial showed that when a dosage of 120,000mg/day was delivered intravenously it accelerated the healing of burned skin dramatically.

Vitamin C Tablets

In terms of treating conditions such as Lyme disease results from several key trials have indicated that combining vitamin C with antibiotics can show some considerable benefits. Antibiotics are recommended for Lyme disease sufferers to help eradicate the infection of the persistent bacteria (Borrelia burgdorferi) which causes the condition. In one set of controlled trials carried out on dairy cows results showed that vitamin C had synergistic effects when combined with antibiotic treatments. These trials were carried out on cows with infected udders and one group was treated just with antibiotics, the other group with a combined treatment of antibiotics and an equivalent dosage of 10,000mg/day of vitamin C (injected). Results showed that the second group with the additional vitamin C treatment recovered much more quickly from the infection, in as much as half the time as those cows receiving just the antibiotic treatment.

Vitamin D

There have been a number of other trials that have revealed that supplements can have synergistic effects when combined with antibiotics.
Vitamin D for example has been shown to be an important vitamin in the body for regulating the immune system result. A lack of vitamin D can result in slow immune responses and difficulty recovering from persistent infections even when receiving antibiotic treatments. One time dosages of 5,000 IU of vitamin D have been shown to be effective at treating the onset of serious bacterial infections such as Lyme disease. Experts recommend that patients receiving high levels of vitamin D are tested regularly to ensure levels remain safe.

Managing Lyme Disease with Supplements and Antibiotics

Results from studies around the world have shown that physicians managing Lyme disease and other persistent bacterial infections can maximize healing and recovery by combining supplements with antibiotics. A number of supplements have been found to be effective at supporting healing during treatment for Lyme disease including olive leaf extract, cats claw and niacin, which can reduce inflammation and has been shown to support healing in the brain. Vitamin C is also a key supplement for treating infections and can be taken in oral supplements of between 2,000 and 10,000mg/day.

For serious Lyme disease infections physicians can use injections to deliver much high level doses of vitamin C, niacin and vitamin D directly to infected sites. These supplements when combined with antibiotics have been shown to accelerate healing and help patients to recover from persistent bacterial infections.

References: ‘Antibiotics and Vitamins Work Together‘  – Orthomolecular Medicine News Service(www.orthomolecular.org)

Early spring is a high risk time for Lyme disease as the ticks that transmit this condition start feeding voraciously in preparation for their breeding season. If you are traveling through tick habitats then you will need to take extra precautions against tick bites, as Lyme disease is an unpleasant condition that can have a number of long lasting symptoms.

Adult Male Deer Tick

Co-Infections

As well as the bacteria that causes Lyme disease ticks can also carry a number of other nasty pathogens. This means that a high number of Lyme disease sufferers could also be infected with additional pathogens. These can complicate treatment and result in much more serious symptoms. The main co-infections that can be transmitted alongside Lyme disease include the parasitic infection Babesiosis and the bacterial infections of Ehrlichiosis (HME or HGE) and Bartonellosis. Experts believe that as many as two thirds of all patients with Lyme disease may have these additional infections as well, many of which will remain undiagnosed.

Dr. Harriet Kotsoris, Medical Director at the Lyme disease research group ‘Time For Lyme’ warns both patients and healthcare advisors about these co-infections:

“Patients infected with Lyme disease are at risk of developing one or more co-infections, tick-borne illnesses that can worsen the severity and/or the duration of Lyme symptoms”

The Centers for Disease Control (CDC) reported that Lyme disease cases rose in 2008 by as much as 28% to over 35,000 reported cases and cases of co-infection are also on the rise.

Adult Female Deer Tick

Treating Co-infections

Many co-infections cannot be treated with the standard antibiotics that are used to treat Lyme disease. Co-infections such as Babesiosis require completely different medications and protocols than Lyme disease and so they must be independently diagnosed and treated separately.

However not much is really about understood about co-infections and there are many disagreements in the health profession on how to best approach this issue. Some healthcare providers believe the antibiotics used to treat the primary Lyme disease infection will also clear up any co-infections that may exist. However many experts advise that because of the different natures of the co-infections a wider scope of antibiotic treatment should be prescribed following an independent diagnosis of each infection.

Diagnosing Co-Infections

It can be difficult diagnosing Lyme disease and co-infections. Traditional methods such as PCRs and serologies can only test for certain species of pathogens (many tick-borne pathogens still remain unidentified). Standard blood analysis is successful only in the first two weeks of the infection and most patients do not actually seek medical help until several weeks after the initial infection. To diagnose Lyme disease and co-infections a series of tests needs to be carried out over a period of time, as it can take as up to four months for infections such as Bartonellosis to manifest and as long as eight months for Babesiosis to appear.

Successful diagnosis of Lyme disease and co-infections must also be based on the history and symptoms of the patient, as the testing is not always reliable.

The California Lyme Disease Association (CALDA) have reported that at least two poster sessions from the IDSA annual meeting back in the fall revealed some alarming concerns regarding the medical guidelines in place for Lyme disease.  These sessions concluded that only 15% of the current ‘strong recommendations’ by the ISDA for the treatment of Lyme disease were based on ‘strong evidence’.

Further to this an article that recently appeared in the Infectious Diseases in Clinical Practice medical journal also highlighted the lack of scientific evidence available to support many key medical guidelines currently in place, such as those for the treatment of Lyme disease.  The author of this article, IDSA member Thomas File, Jr, MD stated that:

‘Ideally, all recommendations from guidelines would be based on high-level, graded evidence (eg, randomized clinical trials). However, because published level I evidence is not often available, guideline writers are challenged with considering a vast array of different levels of support and creating clinically applicable and clear recommendations from it. Only in the minority instances is there an abundance of evidence available that leads directly to an indisputable recommendation.’

Infectious Diseases in Clinical Practice: May 2010 – Volume 18 – Issue 3 – p 151