Lyme Disease Treatment
Two Standards of Care
The medical community has not yet agreed upon the best treatment for Lyme disease and the debate has been heated. There are two schools of thought on Lyme treatment, one promoted by the Infectious Disease Society of American (IDSA) that recommends two weeks of treatment for early Lyme and doesn’t recognize chronic Lyme, and the other promoted by the International Lyme and Associated Diseases Society (ILADS) that recommends individualized treatment, based on patient response to treatment.
CALDA has endorsed the ILADS guidelines, which allow greater exercise of clinical discretion by the physician. It is your doctor’s responsibility to tell you about the different treatment options so that you can make an informed choice.
ILADS doctors are likely to recommend more aggressive and longer antibiotic treatment for patients. They may, for instance, treat “high risk” tick bites where the tick came from an endemic area, was attached a long time, and was removed improperly. They may treat a Lyme rash for a longer period of time than the IDSA recommends to ensure that the disease does not progress. They are unlikely to withhold treatment pending laboratory test results.
Experts agree that the earlier you are treated, the better; and early treatment is often successful. Unfortunately, more than half of the patients treated with short-term antibiotics continue to have significant symptoms. The quality of life of patients with chronic Lyme disease is similar to that of patients with congestive heart failure. Doctors don’t agree about the cause of these ongoing symptoms. The primary cause of this debate is the lack of a diagnostic test that can determine whether the disease has been eliminated from the body in patients who have persistent symptoms.
The IDSA thinks Lyme symptoms after treatment represent a possibly autoimmune, “post-Lyme syndrome” that is not responsive to antibiotics. ILADS physicians believe that on-going symptoms probably reflect active infection, which should be treated until the symptoms have resolved. These physicians are using the types of treatment approaches employed for persistent infections like tuberculosis, including combination treatment with more than one antibiotic and longer treatment durations.
All medical treatment have risks associated with them. While the safety profile of antibiotics is generally quite good, only you (in consultation with your physician) can determine whether the risks outweigh the potential benefits of any medical treatment.
An ILADS doctor may consider the possibility of tickborne coinfections, particularly if a patient does not respond to treatment or relapses when treatment is terminated. Other factors they consider are immune dysfunction caused by Lyme; silent, opportunistic infections enabled by the immune dysfunction; hormonal imbalance caused by Lyme; and other complications.
Considerations while on treatment
Antibiotics impact beneficial intestinal flora and interact with nutritional supplements and foods. It is important to take probiotics while on antibiotics to maintain a healthy intestinal flora. Keep in mind that antibiotics may interact with other drugs or supplements that you are taking. For more information on drug interactions, click here.