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LONG-TERM DOXYCYCLINE FOR LYME DISEASE
Report #7207

Lyme disease can cause horrible muscle and joint pain, severe brain damage, severe nerve damage manifested by loss of feeling in an arm or leg or horrible pain anywhere in the body. Most medical authors recommend treating Lyme disease with 30 days of intravenous Rocephin.

The patient goes to a surgeon who inserts a plastic tube in the veins of his arm. Then the antibiotic is pumped into his veins daily for 30 days at a cost of around 6 or 7 thousand dollars. For the last 5 years I have treated my Lyme disease patients who have muscle and joint pain and fatigue with doxycycline for many months. (However, people who have nerve damage caused by Lyme disease must be treated with intravenous antibiotics). I have been criticized by many of my colleagues for keeping my patients on doxycycline for such a long time. One neurology professor at Johns Hopkins told one of my patients that there was no evidence to treat Lyme disease long term with antibiotics. I have seen many patients who continued to have joint and muscle pain after a month of intravenous antibiotic treatment and they have cleared up completely after taking doxycycline for up to a year. Now I feel vindicated. The literature now shows that long term antibiotics is the only way to cure some patients with Lyme disease and that the $7000 intravenous treatment can fail to cure Lyme disease and that long term doxycycline pills can cure patients with Lyme disease, even after intravenous antibiotics have failed to do so.

By Gabe Mirkin, M.D., for CBS Radio News

ABSTRACT: Two hundred seventy-seven patients with chronic Lyme disease were treated with tetracycline for 1 to 11 months (mean, 4 months); the outcomes for these patients were generally good. Overall, 20% of the patients were cured; 70% of the patients' conditions improved, and treatment failed for 10% of the patients. Improvement frequently did not take place for several weeks; after 2 months of treatment, 33% of the patients' conditions were significantly improved (degree of improvement, 75%-100%), and after 3 months of treatment, 61% of the patients' conditions were significantly improved. Treatment outcomes for seronegative patients (20% of all patients) were similar to those for seropositive patients. Western immunoblotting showed reactions to one or more Borrelia burgdorferi-specific proteins for 65% of the patients for whom enzyme-linked immunosorbent assays were negative. Whereas age, sex, and prior erythema migrans were not correlated with better or worse treatment outcomes, a history of longer duration of symptoms or antibiotic treatment was associated with longer treatment times to achieve improvement and cure. These results support the use of longer courses of treatment in the management of patients with chronic Lyme disease. Controlled trials need to be conducted to validate these observations. See report #G138.

ST Donta. Tetracycline therapy for chronic Lyme disease. Clinical Infectious Diseases 25: Suppl. 1 (JUL 1997):S52-S56. Address ST Donta, Boston Univ, Med Ctr, 88 E Newton St, Evans 6TH Floor, Boston, MA 02118 USA

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