Antibiotics don’t help lingering Lyme effects
For treating Lyme disease, antibiotics are good, but more isn’t better, said a local expert on infectious diseases.
“Two to three weeks on the long end would be considered the standard course,” said Patrick J. Cahill, MD, a physician in the infectious disease clinical service departments at Cape Cod Hospital and Falmouth Hospital. “Anything beyond that I would consider an unnecessary duration.”
More concerning is much longer term – months or years of therapy that some people get for treatment, he said.
“The risks outweigh the benefits that people may be receiving from the antibiotics.”
Dr. Cahill reviewed a study published recently in the New England Journal of Medicine about the long-term use of antibiotics for the tick-borne illness.
The study at a Dutch university followed 280 patients who had been diagnosed with Lyme disease and suffered from its typical symptoms, including muscle and joint aches, fatigue and difficulties with concentration.
All of the patients started with a two-week treatment of an antibiotic called ceftriaxone (known by the brand name Rocephin). Then one group was given a different antibiotic (doxycycline, aka Doryx) for 12 weeks. A second group received a combination of two antibiotics (clarithromycin, aka Biaxin, and hydroxychloroquine, aka Plaquenil) and a third group took a placebo.
Doctors tracked the patients’ symptoms, fitness level, memory and quality of life before, during and after the treatments.
The researchers concluded that there were no significant differences between the three groups.
“I feel that they did a good job reinforcing the data that’s currently out there supporting that longer-term antibiotics do not improve outcomes with Lyme disease,” said Dr. Cahill.
“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,” study senior researcher Dr. Bart-Jan Kullberg, a professor of infectious diseases at Radboud University Medical Center in Nijmegen, the Netherlands, said in a story about the study on the U.S. National Institutes of Health’s (NIH) website.
“Previous clinical trials have not shown that prolonged antibiotic treatment has beneficial effects in patients with persistent symptoms attributed to Lyme disease. Nonetheless, the debate about this issue has continued.”
Dr. Cahill said that antibiotics are “very effective” at killing the Lyme disease bacteria during the standard two to three week course of treatment.
The problem is that symptoms may continue long after that.
“Patients want some relief,” Dr. Cahill said. “I don’t know that patients necessarily are demanding antibiotic therapy, but they’re demanding some sort of treatment for their persistent symptoms.
“Lyme can cause a lot of pain and mental fog. People can have some noninfectious inflammation going on for months and sometimes years, even after being successfully treated for Lyme disease.”
As effective as antibiotics are for treating the Lyme infection, Dr. Cahill says long-term use is not only ineffective for treating ongoing symptoms, it’s “a dangerous practice because they’re subjecting people to what could be very severe side effects.”
Prolonged use of antibiotics “can have collateral damage,” Dr. Paul Auwaerter, a professor of medicine at Johns Hopkins University, told the NIH. “They can disturb your natural microbiome – that is the good bacteria that are in the body. Some antibiotics have side effects, including allergies and irritation of the liver.”
Dr. Cahill said patients should seek treatment for the specific symptoms, which can include anti-inflammatory and anti-seizure medications.
“These patients need customized care, not just a prescription for antibiotics,” Dr. Kullberg told the NIH.
Because there is not yet a sensitive and specific test for diagnosing Lyme disease in its early stages, Dr. Cahill said it makes sense to use short-term antibiotics when symptoms indicate a Lyme infection. “You don’t want to miss it and risk the later manifestations of Lyme disease, which can be severe,” he said.
Finding a better test is an active area of research, he said.
“People are looking at that both from the microbiology end point, as well as how the body responds to a Lyme infection. But right now we’re stuck with the tests we have for the next couple of years at the very least.”
Prevention is vital, he said.
“Basically that’s just having a high index of suspicion and doing very careful tick checks when you’re out in areas where you may be exposed to ticks,” he said. “If you’ve been bitten and pull a tick off yourself and you’re not familiar with what kind of tick it is, then definitely see your doctor right away.”
For more information about ticks and Lyme disease, visit the websites of the Barnstable County Department of Health and Environment and the Cape Cod Cooperative Extension.