Choosing a Lyme Disease Treatment

Lyme disease can become persistent, recurrent, and refractory, even with antibiotic therapy. Therefore, treatment should be prompt and thorough with in-depth follow-up to assess new symptoms and treatment response and to rule out other illnesses.

There is no “one size fits all” treatment protocol for Lyme disease.

There is no “one size fits all” treatment protocol for Lyme disease. Physicians should use their own clinical judgment when determining therapy for their patient. Decisions should not be based exclusively on laboratory findings. Rather, lab results may support the clinical diagnosis and treatment plan.

While it’s important to not delay treatment, physicians need to rule out other medical conditions that share clinical presentations. The presence of co-infections should also be considered. Studies have found that Lyme disease may be more severe and resistant to therapy in co-infected patients. [1] Addressing all tick-borne infections is paramount to a successful recovery.

Other factors that need to be considered when developing a treatment plan include: whether a patient has been prescribed steroids (since steroids can suppress the immune system); how long they’ve been ill; the presence of co-infections; their overall health; and their response to previous treatments.

The duration of therapy should be based on each patient’s individual case.

There has been much debate surrounding the most effective duration of therapy for Lyme disease. Treatment guidelines set forth by the International Lyme and Associated Diseases Society (ILADS) recommend continuing antibiotic treatment for at least 2 months beyond the resolution of symptoms, rather than stopping therapy after a set 30-day period, as suggested by IDSA (Infectious Disease Society of America).

The duration of therapy should be based on each patient’s individual case. The possibility of using multiple antibiotics or switching medications after a poor response should also be considered.

Fatigue in Lyme disease patients can be so severe it’s disabling.

Neurological impairments can manifest within days, and studies have found oral antibiotics are not always effective in treating neuroborreliosis. Instead, physicians may need to administer medications such as intravenous ceftriaxone or cefotaxime, to penetrate the blood-brain barrier.

When choosing a treatment plan, the impact of symptoms on a patient’s daily living should not be minimized. Fatigue in Lyme disease patients can be so severe it’s disabling. Dr. Brian Fallon et al., from Columbia University Medical Center’s Lyme and Tick-Borne Diseases Research Center, described fatigue in Lyme encephalopathy as equivalent to that seen in Multiple Sclerosis patients. [2] In a study by the National Institutes of Health (NIH), Lyme disease patients’ fatigue improved significantly when prescribed IV cefriaxone. [2,3]