Lyme disease treatment

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How is Lyme disease treated on the NHS?

The NICE guideline contains separate tables of treatments for adults and children. The antibiotics which can be used are doxycycline, amoxicillin, azithromycin or ceftriaxone. These include safe options for pregnant women. The choice of antibiotic and the dosage depends, among other factors, on which parts of the body are affected. In most cases a course of antibiotics will last for 3 weeks but in some cases for 4 weeks.

Download: NICE / BMJ antibiotics infographic

NICE and British Medical Journal antibiotics infographic

(Link to antibiotic treatment tables in official guideline)

Doctors should warn patients that a Jarisch-Herxheimer reaction may occur. This is caused when large numbers of bacteria are dying in the body and it will make symptoms worse during treatment. Patients should contact their doctor, but should usually keep taking the antibiotics.

Doctors should consider booking a follow-up appointment during or at the end of treatment to review the patient’s progress. If the patient still has symptoms, the infection may still be present and a second course of antibiotics (a different antibiotic from the one already given) may be needed.

If the patient is not better after treatment, the doctor should consider various possibilities.

  1. The original diagnosis of Lyme disease may have been wrong. More tests may be necessary to look for an alternative diagnosis.
  2. The two courses of Lyme disease treatment may have failed to clear up the infection. Unfortunately there is no test to find out if this is the case. The doctor should not automatically prescribe more antibiotics, but can refer the patient to a specialist and/or discuss them with the National Reference Laboratory to consider other types of Lyme disease test or tests for other tick borne diseases.
  3. There may be symptoms resulting from tissue damage, which may heal over months or years, or may be permanent.

Additional drugs to manage symptoms and complications

Doctors should help people deal with symptoms and other effects of Lyme disease appropriately, including other medications or practical support. Many patients with long term Lyme disease symptoms are prescribed drugs to manage the symptoms of the disease, even if they are not taking antibiotics. The commonest drugs prescribed include painkillers, antidepressants and sleeping pills.

 

Can Lyme disease go away by itself?

Some people are found to have Lyme disease antibodies, without recalling ever having been ill with Lyme disease. When an illness goes away by itself after a while, like a cold or influenza, it is called a “self-limiting illness”. Lyme disease is not a self-limiting illness for some people, but it appears that it is for others.

There is no evidence on how many people have recovered from Lyme disease without treatment, nor a theory as to why some people do whilst others do not.

Alternative and experimental treatments

Long-term antibiotic therapy

Some doctors who treat long-term Lyme disease patients privately – most of whom work outside the UK – prescribe long term antibiotics for patients whose symptoms have not cleared up after standard courses of antibiotics. They may prescribe other drugs as well, intravenous antibiotics or combined antibiotic therapies. Treatments may last months.

These treatments are experimental, as there is a lack of published research demonstrating that such approaches are effective. There is also, however, a lack of evidence that they are not effective. This is a controversial area, amongst patients as well as doctors. More research is desperately needed.

Antimicrobial herbal therapy

Some patients, with persistent symptoms after standard treatment with antibiotics, take herbal remedies.

Commonly used antibacterial protocols for Lyme disease include:

  • Cowden Protocol, claimed to be based on herbs from the rainforst used by native Americans to treat Lyme disease for generations
  • Buhner Protocol, developed by a herbalist who has experimented with his own protocol for Lyme and co-infections
  • Lyme Plus Protocol, developed in Europe by a clinic and university researchers, claimed to target European strains of Lyme and several co-infections.

Nutritional supplements

Some patients with persistent Lyme disease symptoms take nutritional supplements. These are intended to support their immune systems and ease various symptoms but not to cure the infection. Some nutrients commonly taken include magnesium, vitamin C, vitamin B12 and all the B vitamins.

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