Antibiotic Resistance Policy: Impact on Lyme Disease Treatment
Efforts to combat antibiotic resistance are essential—but they may have unintended consequences for patients with Lyme disease.
The federal task force established by Executive Order was charged with developing a national strategy to address antibiotic resistance and accelerate the development of new treatments.
The task force includes leadership from the Department of Health and Human Services, Department of Defense, and Department of Agriculture, along with a Presidential Advisory Council of scientific and medical experts.
At the same time, the President’s Council of Advisors on Science and Technology (PCAST) reported growing concern over antibiotic resistance—linked in part to overuse in both healthcare and agriculture.
The Balance Between Stewardship and Access
I applaud the effort to address antibiotic resistance. This is a serious and growing public health issue.
However, it is equally important to recognize that many patients depend on antibiotics as their primary—and sometimes only—effective treatment.
This is particularly true for individuals with Lyme disease and other tick-borne infections.
For these patients, limiting access to antibiotics may result in prolonged illness and worsening outcomes.
Why Lyme Disease Patients Are Different
Lyme disease is a complex infection that can lead to persistent symptoms, including neurologic, musculoskeletal, and cognitive impairment.
Antibiotics remain the cornerstone of treatment.
The International Lyme and Associated Diseases Society (ILADS) 2014 evidence-based guidelines concluded that, in selected patients, the benefits of antibiotic therapy may outweigh the risks—even in the context of concerns about antibiotic resistance.
These decisions require individualized, patient-specific risk–benefit assessments.
Guideline Perspective
The ILADS guidelines recommend that clinicians discuss retreatment options with patients who have persistent symptoms.
“Clinicians should discuss antibiotic retreatment with all patients who have persistent manifestations of Lyme disease… including patient-specific risk–benefit assessments and potential complications such as C. difficile infection.”
The guidelines also note the role of probiotics in reducing antibiotic-associated risks.
The Public Health Context
According to the CDC, approximately 300,000 cases of Lyme disease are diagnosed annually in the United States.
This does not include additional tick-borne infections, which further increase the burden of disease.
Lyme disease has become a significant public health issue—one that requires both effective treatment and thoughtful policy.
Why This Matters
The current antibiotic resistance strategy does not explicitly address how to preserve access for patients with conditions requiring longer or individualized treatment approaches.
Without such protections, policies designed to reduce antibiotic use may unintentionally limit care for patients who depend on these medications.
Clinical Perspective
Antibiotic stewardship and patient care must be balanced.
Reducing unnecessary antibiotic use is important—but so is ensuring access for patients who benefit from treatment.
Lyme disease specialists and clinicians experienced in treating tick-borne infections should be included in policy discussions.
The goal is not simply to reduce antibiotic use, but to use antibiotics appropriately—while preserving access for those who need them most.
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
