Controversy exists over the significance and even the existence of post-Lyme disease symptoms because of the high rate of similar background symptoms in the general population.
A European, prospective clinical trial in which doxycycline and cefuroxime axetil were compared in the treatment of adult patients with erythema migrans included a control group to address this question. Evaluations of patients were conducted at baseline, 14 days, and 2, 6, and 12 months after enrollment. Control subjects were evaluated at baseline and at 6 and 12 months. Subjective symptoms that newly developed or intensified since the onset of erythema migrans or the date of enrollment for controls were referred to as “new or increased symptoms.”
Doxycycline and cefuroxime axetil had comparable efficacy. At both 6 and 12 months, the frequency of new or increased symptoms in patients with erythema migrans did not exceed the frequency of such symptoms in a control group of individuals of similar gender and age without a clinical history of Lyme disease. At 12 months after enrollment, only 5 (2.2%) of 230 evaluable patients reported new or increased symptoms, and in none of the patients were these symptoms of sufficient severity to be functionally disabling.
No significant differences were identified between doxycycline and cefuroxime axetil in the treatment of European patients with erythema migrans. The frequency of nonspecific symptoms in patients did not exceed that of a control group at ≥6 months after enrollment. We advocate inclusion of appropriate non-Lyme disease control groups in future studies in which nonspecific subjective symptoms are assessed after antibiotic therapy.
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Funding: Slovenian Research Agency.
Conflict of Interest: None of the authors have any conflicts of interest associated with the work presented in this manuscript.
Authorship: All authors had access to the data and played a role in writing this manuscript.
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Subjective Symptoms after Treatment of Lyme DiseaseThe American Journal of MedicineVol. 123Issue 8
- PreviewThe study by Cerar et al1 documents that prompt treatment of patients with early Lyme disease seems to result in generally good outcomes. But some of the inference, perhaps the impetus for the study, is that patients with Lyme disease do not develop any relapsing, persistent, chronic symptoms that can be considered to be due to persistent infection. The fact that the authors acknowledge the controversy, there are patients who have persisting symptoms, and the abundant evidence that both untreated and treated patients with Lyme disease can develop a chronic illness2 needs to be further acknowledged and addressed.
- Persistent Symptoms Following Treatment of Early Lyme Disease: False Hope?The American Journal of MedicineVol. 123Issue 8
- PreviewCerar et al1 conclude that almost all Lyme disease patients treated for an erythema migrans rash with short-course antibiotic therapy have complete resolution of symptoms at 1 year following treatment. Unfortunately, the design of this Slovenian study promotes a false expectation of therapeutic success that cannot be generalized to all patients afflicted with Borrelia burgdorferi, the spirochetal agent of Lyme disease.
- Post-Lyme Disease SymptomsThe American Journal of MedicineVol. 123Issue 8
- PreviewIt is encouraging to see the results of the study by Cerar et al1 showing that 6 and 12 months after enrollment the frequency of symptoms in a group of patients treated for early Lyme disease in Slovenia did not exceed that of a control group without Lyme disease. This is in contrast to the results of our meta-analysis of 5 studies2 in which significantly more Lyme disease patients than controls had fatigue, musculoskeletal pain, and neurocognitive difficulties years after diagnosis and treatment.