About 10 to 20 percent of people who have been infected with 'Borrelia burgdorferi,' the bacteria responsible for the disease, continue to experience symptoms such as muscle disorders, fatigue and cognitive changes even if tests show no remaining signs of the bacteria.
A report just published in the New England Journal of Medicine has demonstrated that long-term use of antibiotics for ongoing symptoms of Lyme disease is not helpful. About 10 to 20 percent of people who have been infected with Borrelia burgdorferi, the bacteria responsible for the disease, continue to experience symptoms such as muscle disorders, fatigue and cognitive changes even if tests show no remaining signs of the bacteria. Many doctors continue to treat these symptoms with antibiotics, which the new study from Radboud University Medical Center in the Netherlands found may not be helpful. The Lyme disease infection is transmitted by Borrelia via infected blacklegged ticks.
Among the 280 people in the trial, no significant differences were found between the physical symptoms of those who were treated with a standard 2-week course of antibiotics versus those treated for an additional 12 weeks. Dr. Bart Jan Kullberg, lead researcher in the new study, said, “This study demonstrates that prolonged antibiotics may not help if you have symptoms after having had Lyme disease.”
The study does not draw any conclusions as to whether those lingering symptoms are related to the Lyme infection or not. Doctors are unable to explain these symptoms since there is no remaining evidence of the bacterium. The Centers for Disease Control and Prevention (CDC) classifies them as Post Treatment Lyme Disease Syndrome, implying they are not sure the symptoms are not caused by something else.
Kullberg says more research is needed to understand these health issues. He says there may be some residual damage to the nervous or immune system, or there may be a “genetic predisposition to these issues.” Regardless, the study has shown that antibiotics are not the solution. However, he also “wouldn’t say that this is proof that the symptoms are not related to the prior infection.”
Other experts on Lyme disease disagree. Executive director of the American Lyme Disease Foundation Philip Baker says, “There’s absolutely no reason why antibiotics shouldn’t clear the infection.”
Others say the tests for Borrelia are not sensitive enough to pick it up in the later stages. According to Dr. Samuel Shor, associate clinical professor at George Washington University Health Care Sciences, the tests do not look for the bacteria, but instead search for antibodies to the bacteria. Sicker patients are less likely to have a big enough immune response to the bug, which means they may test negative. “When they say there is no evidence of Borrelia, they’re saying there is no test evidence. On the other hand, there is clinical evidence, which is the patient sitting in front of you with symptoms.”
The International Lyme and Associated Diseases Society supports the existence of chronic Lyme disease. Shor, who is president of this organization, says he will continue giving antibiotics until the patient is in remission if he feels it will help, and does not intend to arbitrarily withhold treatment after 3 weeks if the patient has not improved.
Kullberg and Baker do not approve. Although they believe that the symptoms are real they do not believe that it is due to active Lyme disease, which would be helped by antibiotics. Baker said antibiotics will not help if the problem is residual damage to the nervous system.
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