Critical review of studies trying to evaluate the treatment of chronic Lyme disease
Revue critique des études essayant d’évaluer le traitement de la maladie de Lyme chronique
Doi : 10.1016/j.lpm.2015.06.002
mardi 21 juillet 2015
Although antibiotic treatment for Lyme disease is effective in some patients, especially during the early phase of the disease, many patients suffer from chronic disease with persisting and evolving signs and symptoms. The role of persistent microorganisms in the pathophysiology of chronic syndromes following Lyme disease treated according to the current recommendations is still being debated [1, 2, 3]. The clinician has no diagnostic test to use in routine practice to check for the persistence of live Borreliae. Several publications show contradictory results regarding the treatment of chronic Lyme disease.
Efficacy of prolonged antibiotic treatment for chronic Lyme disease
The efficacy of long-term antibiotic treatment in patients with chronic Lyme disease or chronic syndromes following tick-bites is still controversial . Several open-label studies have shown that a large proportion of patients with chronic Lyme disease improve after prolonged courses of antibiotic treatment [4, 5, 6]. For their condition to improve, patients with a long history of the disease required longer antibiotic treatments. Several randomized studies tried to evaluate the efficacy of antibiotic treatment versus placebo in chronic Lyme disease. In one study, no difference was shown . In the two following studies, a significant albeit limited beneficial effect of antibiotic therapy was demonstrated. In the study by Krupp et al., a four-week course of treatment with ceftriaxone improved the fatigue syndrome as reassessed at 6 months, with a significant improvement of 64% in the ceftriaxone group versus 18.5% in the placebo group (P
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