Does a “Watch and Wait” Approach Work for Lyme Disease?

Some patients with persistent symptoms after Lyme disease are advised to follow a “watch and wait” approach rather than receive additional treatment. However, several studies suggest that a significant proportion of patients do not fully recover after standard therapy.

What Do the Data Show?

Investigators at Johns Hopkins University followed patients after a standard 3-week course of doxycycline.

• 14% met criteria for Post-Treatment Lyme Disease Syndrome (PTLDS)
• 38% remained symptomatic
• Only 47% returned to their prior level of health at 6–12 months

More than half of patients had not fully recovered 6 to 12 months after treatment.

These findings raise questions about whether observation alone is sufficient for all patients.

Long-Term Outcomes

A separate study from New York Medical College followed patients 11 to 20 years after early Lyme disease.

Approximately 11% continued to meet criteria for PTLDS despite initial treatment.

Many patients also developed additional medical conditions or required hospitalization over time, although the relationship to Lyme disease was not fully defined.

What Happens in Clinical Practice?

Despite recommendations supporting observation in some cases, retreatment with antibiotics is commonly reported in real-world practice.

One analysis of insurance claims found:

• 18% of patients received extended antibiotic courses (average ~86 days)
• 43% were switched between antibiotics
• 18% received combination therapy

These patterns suggest that clinicians often individualize care when symptoms persist.

Is One Approach Enough?

Lyme disease does not always follow a uniform course.

A “one-size-fits-all” approach may not address the variability seen in patient outcomes.

There remains ongoing discussion within the medical community regarding the role of additional treatment versus observation in patients with persistent symptoms.

Clinical Perspective

For some patients, symptoms resolve with time. For others, ongoing symptoms may affect quality of life and daily function.

When more than half of patients report incomplete recovery in some studies, the decision to observe without further intervention may warrant careful consideration.

Shared decision-making—taking into account symptoms, history, and patient preferences—may be an important part of care.

Patients may benefit from understanding persistent symptoms, reviewing treatment variability, and exploring ethical considerations when treatment decisions are uncertain.

References

1. Aucott JN et al. Clin Vaccine Immunol. 2016.
2. Weitzner E et al. Diagn Microbiol Infect Dis. 2016.
3. Nadelman RB et al. Ann Intern Med. 1992.
4. Massarotti EM et al. Am J Med. 1992.
5. Tseng YJ et al. Clin Infect Dis. 2015.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention