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Extended Antibiotic Treatment Doesn't Alter Persistent Post-Lyme Symptoms

Despite receiving appropriate antibiotic therapy for acute Lyme disease, some patients have persistent musculoskeletal and neurocognitive symptoms of unknown cause. This randomized, placebo-controlled, double-blind, NIH-supported trial assessed the efficacy of prolonged antibiotic therapy for the physical and mental symptoms of this baffling condition. Seventy-eight patients seropositive for IgG antibodies against Borrelia burgdorferi and 51 seronegative patients were enrolled. All had histories of clinically documented and appropriately antibiotic-treated acute Lyme disease, followed within 6 months by persistent, widespread musculoskeletal pain, neurocognitive symptoms, or dysesthesias, often accompanied by profound fatigue. No evidence of B. burgdorferi infection was found in any patient by PCR testing of plasma and cerebrospinal fluid (CSF), or in blood or CSF cultures from selected patients.

Patients received either 30 days of ceftriaxone intravenously (2 g/day) followed by 60 days of doxycycline orally (200 mg/day), or intravenous and oral placebos. Enrollment in the trial, designed to include 260 patients, was discontinued early, following an analysis by its data and safety monitoring board indicating little likelihood that differences would occur between treatment groups with full enrollment. One hundred fifteen patients (57 antibiotic and 58 placebo recipients) were evaluated by a standard survey that assesses both physical and mental health. Baseline analyses of all patients demonstrated significant impairments compared with an age-matched, healthy general population. Among antibiotic-treated patients, survey scores improved in 40 percent, were unchanged in 28 percent, and worsened in 32 percent; corresponding values for placebo recipients were 36 percent improved, 29 percent unchanged, and 34 percent worse. Similar analyses sorted by seropositive and seronegative status also revealed no significant differences.

Comment: Although patients with persistent symptoms clearly demonstrate impaired objective health measurements, 90 days of aggressive antibiotic therapy against B. burgdorferi fails to change these impairments. It is unlikely that tinkering with antibiotic choices and durations of therapy will alter these findings.

— N Blacklow

Published in Journal Watch Infectious Diseases July 12, 2001

Citation(s):

Klempner MS et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 2001 Jul 12 345 85-92.

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