Repeated Antibiotic Treatment in Chronic Lyme Disease

Abstract

Patients with chronic Lyme disease who experience persistent cognitive deficits despite having received the recommended antibiotic treatment pose a therapeutic dilemma. This pilot study was designed to assess whether additional antibiotic therapy is beneficial. Enrolled in the study were 23 patients with complaints of persistent memory problems who had previously received 4-16 weeks of intravenous antibiotic therapy. Patients were tested at baseline and 4 months later. During this interval, the private physician determined treatment (intravenous, intramuscular, oral, or none). Assessments included standardized measures of cognition, depression, anxiety, and functional status. Between times 1 and 2, 5 patients were given no antibiotics and 18 were given additional antibiotics: 7 intravenously, 4 intramuscularly, and 7 orally. At time 1, there were no statistically significant group differences in cognition, depression, or anxiety between those who later received antibiotics and those who didn't. At time 1, the 23 patients were also functionally disabled. At time 2, compared with patients who received no antibiotics, patients given antibiotics scored better on overall and individual measures of cognition. Patients given intravenous antibiotics showed the greatest functional improvement (pain, physical functioning, energy) and the most cognitive improvement, even when controlling for baseline differences in cognition between the treatment groups. Patients who did not have a reactive Western blot currently or historically were just as likely to improve cognitively as patients with reactive Western blot results. This uncontrolled study suggests that repeated antibiotic treatment can be beneficial, even among patients who have been previously treated and even among patients who are currently Western blot negative, with the intravenous route of treatment being the most effective. A double-blind placebocontrolled study is needed to confirm these results.