January 18, 2020

Prolonged antibiotics don’t help in Lyme Disease

Lyme disease is a bacterial illness transmitted by tick bites. It is treated with antibiotics, and most guidelines suggest a two to four week course of treatment. Most patients’ symptoms resolve at that point, but 10 to 20% of patients continue to have fatigue, joint and muscle pain, sleep problems, and difficulty concentrating. These patients can be quite debilitated and no specific effective treatment has been found for them.

A patient advocacy group has recommended treatment with antibiotics for months or even indefinitely for what they have called chronic Lyme disease. There has been scant data that such prolonged treatment is effective, and antibiotics can cause side effects and lead to antibiotic resistance. In fact four previous small trials have suggested that prolonged antibiotics do not improve outcomes. Many infectious disease experts doubt the existence of chronic Lyme disease and suggest that these patients may be suffering from a diverse group of other diseases, including chronic fatigue syndrome, fibromyalgia, and sleep disorders. (” target=”_blank”>study in the New England Journal of Medicine tried to answer definitively whether a prolonged course of antibiotics was helpful in patients with prolonged symptoms attributed to Lyme disease.

The study, which took place in the Netherlands, enrolled 281 patients with persistent symptoms attributed to Lyme disease. First, all the patients received two weeks of an antibiotic considered effective for Lyme disease. Then, the patients were randomized to three groups. Patients in the first group received 12 weeks of an antibiotic. Patients in the second group received 12 weeks of a different antibiotic. And patients in the third group received placebo for 12 weeks. Their symptoms were measured regularly for a year.

All three groups on average did equally well. Their symptoms improved steadily throughout the study. Unfortunately at the end of the study all three groups on average had a significantly worse quality of life than the general population. This ” target=”_blank”>Study: Prolonged Antibiotic Treatment Gave No Relief For Lasting Lyme Symptoms (NPR Shots)
” target=”_blank”>Longer-Term Therapy for Lyme Disease (NEJM Quick Take video)
” target=”_blank”>Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease (NEJM article)