Delayed Treatment in Lyme Disease: Risks of Waiting Too Long

Delaying antibiotics in Lyme disease can increase the risk of complications, especially when early treatment is missed.

Patients who do not receive antibiotics or who experience delayed treatment may have worse outcomes than those treated promptly. While this has been well documented in other infections, it raises important concerns about how treatment delays may affect patients with Lyme disease.

What the Study Found

In a large population-based study of elderly patients with urinary tract infections (UTIs), researchers found that more than 13% of patients either did not receive antibiotics or experienced delays in treatment within 60 days of diagnosis.

“The risk of all-cause mortality was significantly higher with deferred antibiotics and no antibiotics than with immediate antibiotics,” write Gharbi and colleagues in the British Medical Journal.

Patients who were not treated promptly had higher rates of bloodstream infection, hospital admission, and death compared with those who received immediate antibiotics.

Why Antibiotics Are Sometimes Delayed

In some cases, antibiotics are delayed or withheld due to concerns about overuse—a practice known as antibiotic stewardship. These programs are designed to reduce unnecessary antibiotic use and limit the spread of antibiotic resistance.

While stewardship is important, it may also contribute to treatment delays when clinicians are uncertain about a diagnosis or are encouraged to avoid prescribing antibiotics early.

Implications for Lyme Disease

Although this study focused on UTIs, the findings raise important questions for Lyme disease.

Early treatment of Lyme disease is associated with better outcomes. Delays in diagnosis or treatment may increase the risk of persistent symptoms, more complex illness, and prolonged recovery.

In clinical practice, Lyme disease can be difficult to recognize. Patients may not recall a tick bite, may present with non-specific symptoms, or may have inconclusive test results. These factors can already delay diagnosis.

Additional delays in starting antibiotics may further increase the risk of complications.

Clinicians must balance the risks of antibiotic overuse with the risks of undertreating a potentially serious tick-borne infection.

Clinical Takeaway

Delayed treatment in Lyme disease may increase the risk of complications and prolonged illness.

When Lyme disease is suspected, timely clinical evaluation and appropriate treatment remain critical to improving outcomes.

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