Lyme disease is a bacterial disease caused by the bacterium Borrelia burgdorferi and is transmitted to humans through the bite of infected ticks. Its symptoms include fever, headache, fatigue, and a characteristic skin rash called erythema migrans.
If Lyme is not treated early, it can cause some people to develop severe symptoms that are hard to resolve. This condition is termed as post-treatment Lyme disease (PTLD) or chronic Lyme disease (CLD).
‘Antibiotics probably are not the right treatment for persistent symptoms associated with Chronic Lyme disease.
Short-term antibiotic treatment is preferred for treating people with early Lyme while the same does not seem to be effective against chronic Lyme. Though some experts prefer long term antibiotic treatment, the effectiveness of it remains unclear as it continues to have significant symptoms.
A new study published in the New England Journal of Medicine
has reported that long-term antibiotic treatment may not be effective in treating chronic Lyme disease.
Kullberg and colleagues from Radboud University Medical Center in Nijmegen enrolled 280 patients in a study called the Persistent Lyme Empiric Antibiotic Study Europe (PLEASE).
"Most patients with Lyme disease are cured after initial antibiotic therapy. But, up to 20 percent of patients report persistent symptoms, such as muscular or joint pain, fatigue or concentration problems, despite initial antibiotic therapy," said study senior researcher Dr. Bart-Jan Kullberg, Radboud University Medical Center in Nijmegen, the Netherlands.
The participants had been diagnosed with either a tick bite or erythema migrans, the significant skin rash or had antibodies to Borrelia burgdorferi. They were divided into three groups based on the specific antibiotic treatment and their quality of life was assessed using a standard questionnaire called RAND-36 Health Status Inventory (SF-36)) before treatment, at the end of the treatment period, and at follow-ups.
All the 280 patients were treated with ceftriaxone for 2 weeks and then they were subjected to a 12-week oral course of different antibiotics regimen. 86 patients in the first group were given doxycycline and 96 patients in the second group received clarithromycin-hydroxychloroquine treatment. The rest 98 of them in the third group were given a placebo.
After 12 weeks of treatments, researchers did not find any significant differences in any of the group. This showed that long-term antibiotic course did not have any effect on the Lyme disease. The SF-36 questionnaire also did not show any improvement in the quality of life.
The authors concluded that in patients with persistent symptoms attributed to Lyme disease, longer-term antibiotic treatment did not have additional beneficial effects on health-related quality of life beyond those with short-term treatment.
Reference: Bart Jan Kullberg, Anneleen Berende, et al. Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease, N Engl J Med 2016; 374:1209-1220, DOI: 10.1056/NEJMoa1505425.