The medical community has not yet agreed upon the best treatment for Lyme disease and the debate has been heated. There are two schools of thought on Lyme treatment, one promoted by the Infectious Disease Society of America (IDSA) that recommend two weeks of treatment for early Lyme and doesn't recognize chronic Lyme, and the other promoted by the International Lyme and Associated Disease Society (ILADS) that recommends individualized treatment, based upon patient response to treatment.
Most Lyme-related organizations (including Midwest Lyme Foundation) have endorsed the ILADS guidelines, which allow greater exercise of clinical discretion by the treating physician. It is your doctor's responsibility to advise you of the different treatment options so that you may make an informed choice.
Early Lyme:
In early Lyme diagnosis, aggressive treatment with antibiotics is the typical therapy. Most cases of early diagnosis (appearance of rash, presence of the infected tick itself, positive test results) this early administration of carefully selected antibiotics has been proven to be very effective in stopping the disease. Although IDSA guidelines call for treatment periods of up to 14-28 days, ILADS doctors are likely to recommend more aggressive and longer antibiotic treatment for patients. Experts agree that the earlier you are treated, the better, and early treatment is often successful.
Late Lyme:
Unfortunately, many people diagnosed with Lyme disease have been sick for some time. Their symptoms may have been misdiagnosed or in many cases, incorrect or false test results were relied upon. These patients fall into the category of late Lyme or chronic Lyme disease. Additionally, if the disease is allowed to progress into late stage, there is a high likelihood of a co-infection or multiple co-infections (discussed later) along with the initial infection of Lyme. These co-infections require specific testing and treatment, in many cases, separate from the Lyme infection itself. Only your medical professional can make these determinations.
The time-honored approach to treatment amongst ILADS professionals for chronic Lyme is prompt and aggressive treatment with antibiotics. These may be administered, orally, by intramuscular injections, or intravenous options, or a combination of all three. This is the area of most disagreement between ILADS and IDSA medical professionals. It must be noted here that all medical treatments have risks associated with them. While the safety profile of antibiotics is generally quite good, only you (in consultation with your treating physician) can determine whether the risks outweigh the potential benefits of any medical treatment.
Although intense and aggressive antibiotic therapy has proven to be effective, antibiotics impact beneficial intestinal flora (bacteria) and interact with nutritional supplements and foods. It's important to take probiotics while on antibiotics to maintain a healthy intestinal function. This is an essential part of treatment and is crucial that it be discussed with your physician.
As each case is individual, there are no agreed-upon timelines for treatment. Most ILADS professionals will continue treatment until positive improvement is noted and maintained. Since there is no definitive test to indicate the eradication of the spirochete that causes Lyme, in many cases an on-going therapy of oral antibiotics for maintenance purposes will be implemented.
Co-infections:
Co-infections are increasingly reported in many patients diagnosed with chronic or late Lyme. Although B. burgdorferi (the spirochete that causes Lyme) remains the most common pathogen in tick-born illnesses, co-infections including Erlichia, Babesia, and Bartonella are some of the most common to be found. These infections are often found in the same ticks that are infected with B. burgdorferi and evidence suggests that these may be transferred at the same time. Recent tests suggest that Lyme disease may be more severe and resistant to therapy in co-infected patients. Thus concurrent testing and treatment for co-infection is mandatory in Lyme disease patients.
Nutrition, supplements, and herbs:
Probotic supplements of "healthy" bacteria help maintain gastrointestinal health and can help offset some of the side effects of taking antibiotics.
Additionally, the use of natural herbs is a time-honored approach to strengthen the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons herbs should be taken with care and under the supervision of a healthcare professional.
Homeopathy:
Unfortunately there are few studies that have examined the effectiveness of specific homeopathic remedies. Professional homeopaths may recommend treatments for Lyme disease based upon their knowledge and clinical experience.
Acupuncture:
Acupuncture may help relieve pain, increase mobility, and reduce fatigue. Chinese herbal formulas, used by many acupuncturists, may help resolve joint, muscular, and neurological symptoms after many courses of antibiotics.
In summary, treatment of chronic or late Lyme is much like the disease itself; complicated and individualized. Not all patients will react to the same treatment protocols. Intense use of antibiotics has potential problematic side effects if not monitored properly and coordinated with other medications. Thus the absolute necessity of a Lyme patient to seek out the best possible medical specialist for the best outcome.
Supporting Research:
ILADS Treatment Guidelines (International Lyme and Associated Disease Society).
IDSA (Infectious Disease Society of America).
CALDA (California Lyme disease Association)
University of Maryland Medical Center; Introduction and treatment of Lyme disease.
