Much uncertainty exists about the cause and treatment of persistent symptoms after a previous episode of Lyme disease. A large-scale study of 280 patients has shown that long-term treatment with antibiotics does not lead to better results than short-term treatment. This is the main conclusion of Radboud university medical center's PLEASE study, which was published in the New England Journal of Medicine on March 30.
The PLEASE study is the first randomized study in Europe to examine the effects of long-term antibiotic use on chronic Lyme symptoms. The study was done because there is much uncertainty about the optimal treatment of people with persistent symptoms after a tick bite. It included 280 people with symptoms such as muscle and joint pain, fatigue and concentration problems. All of them were previously diagnosed with Lyme disease.
During the first two weeks, all participants were given the antibiotic ceftriaxon. Then they were divided into three groups. The first group was given the antibiotic doxycycline for 12 weeks, the second group was given a combination of the antibiotics clarithromycin and hydroxychloroquine, and the third group was given a placebo. The subjects were randomly allocated to the groups (randomized), and neither participants nor doctors knew who was in which group (double blind study). Professor of Medicine and Infectious Diseases Bart Jan Kullberg: "Before and after treatment, the participants completed questionnaires about their symptoms, their fitness level, quality of life and wellbeing. They repeated this after 26, 40 and 52 weeks. In addition, they took memory tests and used a pedometer to record their movement."
No clear differences between the three groups were observed at any of these time points. Kullberg: "Longer treatment is required for some forms of Lyme disease. However, based on the results reported by the participants themselves, we must conclude that long-term use of antibiotics does not help patients who previously had Lyme disease and continue to report unexplained, persistent symptoms. These patients need customized care, not just a prescription for antibiotics."
Persistent Lyme symptoms
Lyme disease is caused by the bacterium Borrelia burgdorferi, which is transmitted by a tick. This disease is characterized by a red spot, the erythema migrans, which slowly increases in size. Only a small proportion of people with a tick bite actually develop Lyme disease. In many patients, the disease is cured completely by treatment with antibiotics lasting between ten days and four weeks. However, a few patients report persistent symptoms after treatment. In some cases, late onset of the disease can also occur if the infection is not detected at an early stage or if it is not treated with antibiotics.
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