http://www.nejm.org/doi/full/10.1056/NE ... articleTop
Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease
Anneleen Berende, M.D., Hadewych J.M. ter Hofstede, M.D., Ph.D., Fidel J. Vos, M.D., Ph.D., Henriët van Middendorp, Ph.D., Michiel L. Vogelaar, M.Sc., Mirjam Tromp, Ph.D., Frank H. van den Hoogen, M.D., Ph.D., A. Rogier T. Donders, Ph.D., Andrea W.M. Evers, Ph.D., and Bart Jan Kullberg, M.D., Ph.D.
N Engl J Med 2016; 374:1209-1220
March 31, 2016
There was also (predictably) another article written by Melia and Auwaerter citing this study in the same NEJM publication. The full text is available at the link, but I have included the first paragraph below:Patients with Lyme disease, which is caused by the Borrelia burgdorferi sensu lato complex (including B. afzelii and B. garinii in Europe), often report persistent symptoms.1 These symptoms are also referred to as the post–Lyme disease syndrome or chronic Lyme disease and may occur after resolution of an erythema migrans rash or after other — possibly unnoticed — manifestations of early Lyme disease, regardless of whether a patient received initial appropriate antibiotic treatment. Patients present mainly with pain, fatigue, and neurologic or cognitive disturbances.2,3
Previous randomized, clinical trials have not shown convincingly that prolonged antibiotic treatment has beneficial effects in patients with persistent symptoms attributed to Lyme disease.4-6 Nonetheless, the debate about this issue has continued.7 Although most guidelines do not recommend antimicrobial therapy for longer than 2 to 4 weeks,8,9 other guidelines recommend prolonged antibiotic therapy.10 We performed a randomized, double-blind, clinical trial (Persistent Lyme Empiric Antibiotic Study Europe [PLEASE]) that included three study groups to compare shorter-term treatment (ceftriaxone followed by placebo [placebo group]) with longer-term treatment (ceftriaxone followed by doxycycline [doxycycline group] or ceftriaxone followed by the combination of clarithromycin and hydroxychloroquine [clarithromycin–hydroxychloroquine group]).
Time for a Different Approach to Lyme Disease and Long-Term Symptoms
Michael T. Melia, M.D., and Paul G. Auwaerter, M.D.
N Engl J Med 2016; 374:1277-1278
March 31, 2016
To complete the information that I have found so far on this, there was also a Health Shots article from NPR:The condition of most patients with Lyme disease improves after initial antibiotic therapy; however, 10 to 20% of treated patients may have lingering symptoms of fatigue, musculoskeletal pains, disrupted sleep, and lack of customary mental functions. The plausible idea that additional antimicrobial therapy for potentially persistent bacterial infection would foster improvement has been a touchstone of hope in the 40 years since discovery of the disease in the mid-1970s. Patients with long-standing symptoms and well-documented, previously treated Lyme disease have been the focus of a number of randomized, placebo-controlled studies in North America that assessed whether additional antibiotic therapy offers a reduction in symptoms.1 Because molecular or culture methods did not find evidence of persistent infection in the enrolled patients, it was perhaps not surprising that additional antimicrobial therapy yielded neither clinically significant nor durable reductions in symptoms as compared with placebo.
Study: Prolonged Antibiotic Treatment Gave No Relief For Lasting Lyme Symptoms
March 30, 20165:01 PM ET
http://www.npr.org/sections/health-shot ... =hootsuite
Rest of the article is available from the above link.For some people with Lyme disease, the illness seems to take a lasting toll.
Years after a standard two-week course of antibiotics against Borrellia burgdorferi or closely related organisms that cause the disease, these patients remain exhausted and foggy-headed. They suffer from chronic aches and pains and poor sleep.
In the last decade and a half, medical societies and some patient groups have fought over how to treat these people and also over the reasons why they don't get better.
Some doctors and guidelines recommend long-term antibiotic treatment for these Lyme disease patients. The National Institutes of Health and the Infectious Disease Society of America maintain, however, that prolonged antibiotics use doesn't help, and advise doctors to limit antibiotics to the initial course.
Results from a clinical trial published Wednesday in the New England Journal of Medicine support the recommendation against long-term antibiotic treatment. Researchers in the Netherlands randomly assigned 281 people with persistent symptoms who had been diagnosed with Lyme disease to three groups. First, though, all the people were treated with antibiotics for two weeks. Then, a third got a placebo, a third got one kind of antibiotic and the remaining third got different antibiotics for a period of three months.
At the end of the trial, no group of patients did better than the other. "They were not helped by prolonged antibiotic treatment," says Dr. Bart-Jan Kullberg, a senior author on the study and an infectious disease researcher at Radboud University in the Netherlands.
The study already has detractors. "You do a lousy study that's designed to fail, and you get a failed study. And that's basically what this is," says Dr. Raphael Stricker, a board member of the International Lyme and Associated Diseases Society , or ILADS, which advocates for the long-term use of antibiotics therapy.........