Despite all the controversy over diagnosis and treatment of Lyme Disease it is good to see the NHS Map of medicine open minded to the fact that some patients may need long term antibiotics.
Fortunately it was my positive response to antibiotics which led my GP to suspect Lyme Disease. My Arthritis and muscle weakness significantly improved on a chance course of Amoxycillin given for chest throat and sinus infection. The record was on the computer when I had visited the surgery with bites bulls eye rashes summer flu and migrating arthralgias. Many of the over 2000 patients I am in touch with on Eurolyme do not respond quite so quickly as I did, but it is good to have access to the NHS Map of medicine when discussing treatment options with our doctors.
Last reviewed: 28-Jan-2010 Due for review: 29-Feb-2012 Printed on: 11-Feb-2010 © Map of Medicine Ltd All rights reserved
Last reviewed refers to the date of completion of the most recent review process for a pathway. All pathways are reviewed regularly every twelve months, and on
an ad hoc basis if required.
• for late Lyme disease:
• cefotaxime is likely to be beneficial
• it is not known whether ceftriaxone is beneficial when given alone
• ceftriaxone in combination with doxycycline is not effective
• long-term antibiotic therapy in patients with persistent symptoms is thought to provide no additional benefit
• monitor response based on clinical improvement
• beware of potential adverse drug reactions
• Jarisch-Herxheimer reactions may occur shortly after start of treatment
• patients should have daily electrocardiograms (ECGs) during admission to detect evidence of cardiac conduction defects
The alternative view by the International Lyme and Associated Diseases Society (ILADS) is:
• treatment with antibiotics is needed for a longer duration than is currently common practice, especially in patients with
continuing symptoms (post-Lyme syndrome)
• some studies have shown that longer courses of antibiotics (eg one month of IV ceftriaxone) improve the primary outcome of
fatigue in post-Lyme syndrome as well as improvements in long-term cognition and physical functioning
In the absence of current consensus between IDSA and ILADS:
• longer course (more than 21 days) of antibiotics may be beneficial in some sub-groups of patients, eg Lyme encephalopathy,
post-Lyme disease, after consultation with Lyme experts'
What better Lyme experts are there than those affiliated to ILADS considering the thousands of patients they see most of which find their symptoms improve on long term treatment.