Do Antibiotics Work for Lyme Disease? Evidence and Studies

Antibiotics for Lyme disease are widely used, but an important question remains: do they help patients who present primarily with non-specific symptoms? An article entitled “Antibiotic treatment in patients that present with solely non-specific symptoms and positive serology at a Lyme centre,” published in the European Journal of Internal Medicine, examines whether antibiotic therapy benefits patients with positive Lyme serology who present mainly with subjective symptoms.

The study examined 97 patients who had non-specific symptoms and positive immunoglobulin G (IgG) serology for Lyme disease but had not previously received antibiotic treatment.

These symptoms were considered “non-specific,” meaning they were not classic objective manifestations of Lyme disease.

Non-specific symptoms included:

• Myalgia or arthralgia
• Fatigue (including lethargy and loss of energy)
• Sleep disturbances
• Headache
• Inflammatory symptoms (fever, temperature elevation, sore throat, night sweats)
• Cognitive difficulties
• Sensory disturbances
• Digestive symptoms
• Dizziness or lightheadedness
• Shortness of breath or palpitations
• Mood disturbances

These symptoms are commonly reported by patients with persistent Lyme disease symptoms or Post-Treatment Lyme Disease Syndrome (PTLDS).

The researchers examined whether these patients benefited from antibiotic therapy and whether certain patient characteristics predicted treatment response.

Do Antibiotics Help Lyme Disease Symptoms?

The investigators found that nearly half of the patients experienced some improvement following antibiotic therapy.

Of the 97 patients treated:

• 15.5% experienced a clear improvement
• 26.8% experienced an intermediate improvement
• 50.5% experienced no improvement

Most of the participants were adults, and more than 70% were men. On average, the non-specific symptoms had been present for approximately two years before treatment.

Doxycycline and amoxicillin were the antibiotics used to treat Lyme disease. Most patients received a four-week course of therapy.

Interestingly, patients with inflammatory symptoms appeared to benefit the most from doxycycline.

[bctt tweet=”Does a short course of antibiotics help Lyme disease patients who have non-specific symptoms such as fatigue, mood disturbances and sleep disturbances?” username=”DrDanielCameron”]

The authors also noted that “patients with symptoms suggestive for inflammatory disease and patients with the IgG immunoblot antigen p58 benefited significantly more often from antibiotic treatment compared to patients without these characteristics.”

Authors’ Conclusions

The authors concluded that antibiotics may have some effect in previously untreated patients with non-specific symptoms and positive Lyme serology.

However, they emphasized that many patients experienced only intermediate improvement.

The researchers suggested that a randomized controlled trial (RCT) is needed to validate these findings.

They also raised the possibility that symptom improvement could have resulted from treatment of another pathogen rather than Borrelia burgdorferi, the bacterium responsible for Lyme disease.

“Symptoms suggestive for inflammatory disease were associated with treatment effect,” the authors wrote, suggesting that antibiotics may have acted on pathogens related to diseases other than Lyme borreliosis.

Studies That Dispute Antibiotic Benefits

Other studies have reached different conclusions.

For example, the Klempner clinical trial, sponsored by the National Institutes of Health (NIH), concluded that antibiotics did not significantly benefit patients with persistent symptoms following Lyme disease.

However, that study enrolled patients who had been ill for an average of 4.7 years and had already undergone an average of two prior antibiotic treatments.

Another NIH-sponsored trial led by Krupp and colleagues found that antibiotics provided improvement for Lyme disease patients suffering from fatigue, although they did not improve other symptoms.

Editor’s Note

The study published in the European Journal of Internal Medicine has several limitations. Treatment effectiveness may have resulted from the treatment of another pathogen rather than Lyme disease itself. Additionally, the study lacked a controlled comparison group.

Nonetheless, the results should encourage further research into the role of antibiotics in Lyme disease patients who present primarily with non-specific symptoms.

Clinical decisions regarding antibiotic treatment for Lyme disease often require balancing incomplete evidence with the potential risks of untreated infection.

The question of whether to offer treatment when evidence is mixed—and the consequences of withholding it—is at its core an ethical one, explored further in the ethics of Lyme disease diagnosis and treatment.

Clinical Takeaway

This study suggests that some patients with positive Lyme serology and non-specific symptoms may experience improvement with antibiotic therapy. However, the mixed results highlight the ongoing uncertainty surrounding the treatment of persistent Lyme disease symptoms and underscore the need for further research.

Frequently Asked Questions

Are antibiotics effective for Lyme disease?

Antibiotics are the standard treatment for Lyme disease, particularly in early infection. However, some patients continue to experience symptoms after treatment.

Do antibiotics help patients with non-specific Lyme symptoms?

Some studies suggest that a subset of patients with positive Lyme serology and non-specific symptoms may benefit from antibiotics, although results are mixed.

Can Lyme disease symptoms persist after antibiotics?

Yes. Some patients experience persistent symptoms following treatment, a condition referred to as Post-Treatment Lyme Disease Syndrome (PTLDS).

Related Articles:

Could dormancy allow Lyme disease to survive antibiotics?

In culture, novel combinations of antibiotics prove effective for Lyme disease

Limits on antibiotics for Lyme disease leave doctors in limbo

References:

1. Nijman G, van Kooten B, Vermeeren YM, van Hees BC, Zomer TP. Antibiotic treatment in patients that present with solely non-specific symptoms and positive serology at a Lyme centre. Eur J Intern Med. 2020.
2. Klempner MS, Hu LT, Evans J, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001.
3. Krupp LB, Hyman LG, Grimson R, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double-masked clinical trial. Neurology. 2003.

---

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