Twelve weeks of antibiotic therapy have appeared ineffective in people with long-term symptoms of Lyme disease, according to a new Dutch study.

Dubbed PLEASE, the research was the largest ever to be conducted on patients with chronic symptoms post-episode of Lyme infection. It showed that three-month antibiotic therapy did not demonstrate added benefits to patients who reported persistent pain, mental confusion, and fatigue.

While most Lyme disease patients are cured after the first antibiotic treatment, up to 20 percent report continuing symptoms.

“[The participants] report persistent symptoms, such as muscular or joint pain, fatigue or concentration problems, despite initial antibiotic therapy,” says senior study author and infectious diseases professor Dr. Bart-Jan Kullberg.

The team recruited 280 patients in Europe who were afflicted with Lyme disease symptoms and were previously diagnosed with the condition. The subjects were given the antibiotic ceftriaxone, and then after two weeks were administered one of the following: antibiotic doxycycline, a combination of clarithromycin and hydroxychloroquine, or placebo.

After the patients completed questionnaires and took physical and memory tests, the researchers saw no clear differences between the three groups at any time during the evaluations.

“The patients reported no benefit of prolonged antibiotics on any of the scales compared to those who received placebo,” says Kullberg, encouraging customized care instead of mere antibiotic prescriptions.

The patients’ quality of life is no different from those with cancer or rheumatoid arthritis, said Kullberg. Mostly minor side effects, too, manifested in 68.6 percent of patients – something doctors could use to reconsider prescribing long-term antibiotics, according to Johns Hopkins’ Drs. Michael Melia and Paul Auwaerter in an editorial.

The Infectious Diseases Society of America is recommending against antibiotic therapy in treating Lyme symptoms. American Lyme Disease Foundation executive director Phillip Baker, too, said the findings aligned with conclusions from four NIH-backed clinical trials showing no gain from extended antibiotic treatment.

The findings, however, have their share of detractors, with long-term antibiotic therapy advocate Dr. Raphael Stricker, also a board member of the International Lyme and Associated Diseases Society, dubbing it “a lousy study that’s designed to fail.”

The debate on Lyme disease dates back to its discovery four decades ago, with experts divided over considering it a real disease or a host of symptoms of an undiagnosed illness. The disease is caused by a tick-transmitted bacteria called Borrelia burgdorferi and is characterized by a bulls-eye-like red rash.

Kullberg speculated that Lyme patients struggled long after treatment for several likely reasons, such as residual damage from the infection or ongoing immunological response. At any rate, doctors are puzzled as to why these patients remain sick, he said.

The findings were discussed on March 31 in the New England Journal of Medicine.

Photo: Lennart Tange | Flickr

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