There’s debate about the best way to treat Lyme disease.
How doctors should treat Lyme patients who remain sick after antibiotics is a controversial topic. “It’s the million-dollar question,” says Stephen Barthold, D.V.M., a veterinary pathologist at the University of California in Davis who has studied Lyme disease in animals for decades. At its core, the issue is this: Are lingering symptoms caused by a continuing infection—which would mean Lyme bacteria are capable of surviving an antibiotic onslaught? Or are those symptoms caused by something else, like tissue damage or an abnormal immune reaction?
Here’s what everyone seems to agree on: When Lyme isn’t treated, in some people initial symptoms may dissipate for months and then reemerge. Lyme disease can progress to damage the joints and even the heart. Even among those who do get treated, as many as one in five may develop PTLDS.
Barthold’s team has found that in many animals, including nonhuman primates, Lyme bacteria can indeed survive antibiotics. But it’s unclear if the same is true in people.
Scientists have tried to address the question by seeing whether patients improve after getting extra antibiotics. But analyzing these results is complicated, too. While some clinical trials have found evidence that repeated or prolonged antibiotic treatments can improve fatigue and cognitive decline, others have not.