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We describe the clinical courses of 5 patients with
Lyme disease who developed significant late complications, despite receiving tetracycline early in the course of their illness. All 5 patients had been treated for erythema chronicum migrans with a course of tetracycline that met or exceeded current recommendations. The late manifestations of
Lyme disease included arthritis, cranial nerve palsy, peripheral neuropathy, chronic fatigue, and changes in mental function. Our findings suggest that the use of tetracycline at a dosage of 250 mg, 4 times a day for 10 days, as a treatment for early
Lyme disease should be reconsidered. To determine optimal therapy for early
Lyme disease, a study that compares an increased dosage of tetracycline with alternative treatments is indicated.