Most medical experts agree on two things regarding the treatment of Lyme disease:
- The earlier Lyme patients are treated, the better chance they have to recover.
- Antimicrobial therapy is the preferred treatment for Lyme disease.
And that’s where agreement ends. Every other issue related to the diagnosis and treatment of Lyme is hotly debated – so hotly debated that the controversy has been dubbed “The Lyme Wars.”
There are two primary schools of thought when it comes to treating Lyme disease. One is promoted by the Infectious Diseases Society of America (IDSA) and endorsed by the CDC. The other is promoted by the International Lyme and Associated Diseases Society (ILADS) and is supported by most Lyme-literate doctors. Here are some of the key areas of disagreement.
|Prophylaxis (preventive treatment) after tick bite||Not usually recommended but may give one 200 mg dose of doxycycline if several strict conditions are met.||Preferred regimen is 100-200 mg of doxycycline, twice daily for 20 days, if patient agrees.|
|Early Lyme: to treat or not to treat?||Although the CDC recommends a clinical diagnosis for Lyme, many doctors will withhold treatment pending test results.||Doctors base their decision to treat on a clinical diagnosis because currently approved testing methods are highly unreliable.|
|Early Lyme: standard treatment protocol||Recommend treating for 10-21 days depending on which antibiotic is used.||Generally recommend 4-6 weeks of antibiotic therapy, depending on patient’s response.|
|Late (chronic) Lyme||Believes chronic Lyme is rare, if it exists at all. Attributes post-treatment symptoms to a possible autoimmune disorder – “Post-Lyme Syndrome.” Does not support long-term antibiotic therapy.||Believes that post-treatment symptoms probably indicate an active infection, which should be treated as long as necessary. Supports long-term antibiotic therapy|
|Alternative & Complementary Treatments||Does not support the use of any alternative treatments, including nutritional supplements.||Supports the use of appropriate alternative treatments based on the individual patient’s needs.|
In a nutshell, IDSA uses strict standards that allow little flexibility, while ILADS recommends individualized treatment based on the patient’s needs and response to treatment.
Other Lyme Treatments
When Lyme disease is not diagnosed for a long period of time or when it does not respond to antibiotic therapy, it can become a chronic illness. At that point, it usually requires a multi-faceted, integrative approach to treatment. In addition to antibiotics, most Lyme specialists recommend a combination of herbal remedies, nutritional supplements, a special diet and non-aerobic exercise. It often takes many months, or even years, to recover from long-standing chronic Lyme disease.
For more detailed information about treatments for Lyme disease, see:
“Lyme Disease Treatment.” LymeDisease.org. Retrieved April 29, 2015.
Cameron, D.J., et al. “Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease.” Expert Review of Anti-Infective Therapy. September 2014.
Wormser, G.P., et al. “The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America.” Clinical Infectious Diseases. November 1, 2006.
Last Updated: 5/5/15
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