Early Lyme Disease Treatment Effective
The researchers in this latest study (NCT00910715) looked at how patients with erythema migrans, but no disseminated Lyme disease symptoms, responded to early treatment with doxycycline. This treatment has been assessed for patients in the US but this study, taking place in Slovenia, represents the first example of such research for European Lyme disease cases. Adult patients with a Lyme disease rash but no clinical signs of Lyme disease having become systemic were treated with a ten-day doxycycline course, with the exception of patients who were pregnant, lactating, or who were immunocompromised. The drug regimen consisted of two 100mg doses of oral doxycycline daily and the study took place at the University Medical Center in Ljubljana, Slovenia.
Shorter Lyme Disease Treatment Works
Dr. Franc Strle was the lead researcher for this unrandomized study into Lyme disease treatment which involved 225 patients. In both the ten-day treatment group and the fifteen-day treatment group the symptoms of Lyme disease skin lesions (erythema migrans) subsided an average of seven days after the patients began treatment. There appeared to be no benefit to continuing the doxycycline regime after the ten-day period and, indeed, the shorter course of antibiotics was actually found to have the slight advantage of reducing the incidence of side-effects from doxycycline. Patients in the ten-day Lyme disease treatment group had a lower rate of photosensitivity with the antibiotic which is one of the most common side-effects noted when taking this drug.
Alternative Lyme Disease Antibiotics
Alternatives to doxycycline for Lyme disease treatment include amoxicillin at a dose of 500mg three times a day for two weeks, or cefuroxime at 500mg twice a day for two weeks. Azithromycin is also used for patients with erythema migrans when they cannot take doxycycline and are allergic to beta-lactan antibiotics.
Problems with Lyme Disease Diagnosis
Patients enrolled in the study did not all have a positive antibody titer for Borrelia at the time of enrolment; in fact, just 13.8% of patients were seropositive and these all became seronegative after treatment. Erythema migrans is a very distinct skin rash that is used for Lyme disease diagnosis and so it is unlikely that patients were misdiagnosed at the start of the trial, making it difficult to determine why such a small number had positive Lyme disease test results. Almost all patients were deemed to have a complete response to the Lyme disease antibiotics at the two month mark, with 84.6% free of objective manifestations of Lyme borreliosis in the ten-day treatment group and 86.7% Lyme disease-free in the fifteen-day treatment group. At the twelve month mark 93.4% of patients in the fifteen-day group were deemed to have had a complete response to treatment, and 91.9% of the ten-day group were also evaluated as having responded fully to treatment. Interestingly, thirteen patients (5.8%) had new or increased symptoms at twelve months after treatment but none were determined to have post-Lyme disease syndrome by the researchers. In light of more recent research it is possible that the patients continuing to have symptoms may actually be infected with another tick-borne pathogen, the newly uncovered Heartland virus.
European Lyme Disease Treatment
There continues to be disagreement between Lyme disease doctors over the importance of post-Lyme disease treatment symptoms and the existence of Chronic Lyme disease. Some of the confusion may lie in the differing symptoms experienced by patients in Europe and in the US due to the specific strain of Borrelia causing the infection. In the US it is thought that Borrelia burgdorferi sensu stricto is responsible for almost all infections and that this bacteria tends to cause Lyme arthritis in many cases. The European Lyme disease bacterial strains such as B. afzelii, and B. garinii are thought more likely to result in acrodermatitis chronica atrophicans, and neurological manifestations of Lyme disease, respectively, rather than Lyme arthritis symptoms.
Lyme Disease Rash Questions
Understanding the differing clinical signs of Lyme disease in Europe and the US can help create a better system of differential diagnosis for Lyme disease so as to avoid delays to treatment. In all cases it appears that early symptoms of Lyme disease are easily dismissed as a flu-like illness, especially in cases where the distinctive Lyme disease rash is not present or not observed. This latest study also supports the view that doctors face considerable difficulties in detecting Lyme disease with current testing methods as, even when the clear Lyme disease rash is present, the majority of patients did not test positive for Lyme disease bacteria.
Lyme Disease Treatment Complications
Cynics may point out that this latest study simply confirms what we already knew; early-stage localized Lyme disease is usually simple to treat with a short-course of antibiotics. What remains unknown is why so many appear to be plagued by Lyme disease symptoms even when seronegative and after extensive long-term antibiotic treatment. At least this study supports the use of a shorter course of antibiotics for Lyme disease which may save some patients from side-effects, but more research is still needed into long-term Lyme disease complications.
Daša Stupica, Lara Lusa, Eva Ružić-Sabljić, Tjaša Cerar, and Franc Strle, Treatment of Erythema Migrans With Doxycycline for 10 Days Versus 15 Days, Clin Infect Dis. (2012), doi: 10.1093/cid/cis402, First published online: April 20, 2012