Why Long-term Antibiotics for Lyme Disease is Quackery

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Decades of research have demonstrated with overwhelming evidence that Lyme disease is easily cured with generic antibiotics, even in late stage.

However, some individuals with a history of Lyme disease may have persistent symptoms even after treatment. These symptoms have been called Post-Treatment Lyme Disease Syndrome (PTLDS) and usually diminish with time.

Some questioned whether PTLDS is caused by a persistent Lyme disease infection and proposed that long term antibiotics may help such patients.

Patients who received long term antibiotics have zealously evangelized for long-term antibiotic treatment because they believed it helped them.

But, as Dr. Harriet Hall describes in her course on Science-Based Medicine, we humans may believe ineffective treatments work for many reasons:


  1. The disease may have run its natural course.
  2. Many diseases are cyclical.
  3. We are all suggestible.
  4. The wrong treatment may get the credit.
  5. Diagnosis and prognosis may be wrong.
  6. Temporary mood improvement confused with cure
  7. Psychological needs affect behavior and perceptions
  8. We confuse correlation with causation

Randomized controlled trials (RCTs) are experiments that help remove human biases that may influence results. In an RCT, subjects are randomly assigned to either a group receiving a control treatment (usually a placebo) or a group receiving the treatment being tested.

Ideally, the subjects should be blinded so they do not know which treatment they are receiving. The outcomes of the groups are then compared.

As shown below, four American RCTs and two European RCTs all found long term antibiotics did not outperform placebo. These trials also showed that antibiotics can cause severe side effects.

Of course, a number of studies found that false Lyme diagnoses are common. Lyme disease was never the cause of the problems in the vast majority of quackery victims who receive a fake “chronic Lyme” diagnosis.

Well-designed RCTs can provide strong evidence regarding drug safety and efficacy. However, because no single study is definitive, it is important to base treatment decisions on multiple studies.

In addition to RCTs, systematic reviews (listed below) all found that long term antibiotics are not warranted for Lyme disease.

A systematic review is a type of study that summarizes the evidence of multiple studies into one document. A meta-analysis uses statistical methods to compile data from multiple studies into summary measures. These types of studies are considered even stronger evidence than RCTs on the hierarchy of scientific evidence shown below, as explained by TheLogicOfScience.com.

Hierarchy of Scientific Evidence in order from strongest to weakest: Meta-analyses and systematic reviews, Randomized Controlled Trials, cohort studies, case-control studies, cross-sectional studies, animal trials and in vitro studies, case reports, opinion papers, and letters

Not scientific evidence:

  • YouTube and Netflix videos
  • Personal anecdotes (“It worked for me!”)
  • Gut feelings
  • Parental instincts
  • some guy you know
  • Chronic Lyme support groups
  • “Lyme literate” doctors
  • Functional and integrative medicine practitioners
  • Naturopaths, chiropractors, and homeopaths
  • Internet surveys like MyLymeData
  • Other red flags of Chronic Lyme quackery

Because they may not apply to humans, studies in animals and in vitro (petri dish or test tube) are among the weaker forms of evidence when determining if a treatment is safe and effective.

Cherry picked evidence may introduce bias. Therefore, case reports and opinion papers are also considered to be weak.

Proponents of fake chronic Lyme diagnoses and treatments frequently use weak evidence (e.g. from animal or petri dish experiments) to justify their beliefs. They also ignore the overwhelming stronger evidence that contradicts their beliefs.

In 2010, members of an independent review panel unanimously agreed that the 2006 Lyme disease guidelines produced by the Infectious Diseases Society of America (IDSA) were medically and scientifically justified. The review panel was certified by an independent ombudsman to be free from conflicts of interest.

Among other things, the review panel concluded:

  • In the case of Lyme disease, inherent risks of long-term antibiotic therapy were not justified by clinical benefit.
  • To date, there is no convincing biologic evidence for the existence of symptomatic chronic B. burgdorferi infection among patients after receipt of recommended treatment regimens for Lyme disease.

The IDSA recommendations are consistent with recommendations from medical and scientific organizations around the world.

Since 2010, the evidence against long term antibiotics and “chronic Lyme” has become only stronger. Therefore, whether the Lyme diagnosis is real or fake, long term antibiotics can be considered quackery.

More than placebo?

Based on 6 placebo-controlled trials, we know that longterm antibiotics are not needed for treatment of Lyme disease. However, some patients claim that they feel better while on antibiotics. Are these reports from placebo effects or is something else happening?

Some antibiotic drugs commonly prescribed for Lyme disease—including ceftriaxone (Rocephin) and tetracyclines like doxycycline — have natural anti-inflammatory properties.

For example, one study found that patients who received an injection of ceftriaxone prior to surgery could withstand more pain than similar patients who received either placebo or a different antibiotic.

Because of the pain-relief potential of some antibiotics, feeling better on an antibiotic is therefore not necessarily an indication that the antibiotic killed bacteria that was causing harm. And if pain relief is required, other anti-inflammatory drugs—like ibuprofen (brand names: Advil, Motrin, Brufen, Nurofen)—are much safer.

Independent Systematic Reviews

The following reviews are in addition to those listed on our scientific consensus page.

UK NICE Guidelines, 2018.

German S3 guideline on Lyme neuroborreliosis, 2018. (English | Deutsch)

Cadavid D, et al. Antibiotics for the neurological complications of Lyme disease. Cochrane Database Syst Rev. 2016;12:CD006978.

Sanchez E, et al. Diagnosis, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: A Review. JAMA. 2016;315(16):1767-77. [pdf mirror]

Dersch R, et al. Efficacy and safety of pharmacological treatments for acute Lyme neuroborreliosis – a systematic review. Eur J Neurol. 2015;22(9):1249-59.

The 6 Negative Randomized Placebo-controlled Trials

The Berende Trial 🇳🇱

Berende A, et al. Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease. N Engl J Med. 2016;374(13):1209-20. [Persistent Lyme Empiric Antibiotic Study Europe (PLEASE)]

Berende A, et al. Effect of prolonged antibiotic treatment on cognition in patients with Lyme borreliosis. Neurology. 2019;

Berende, A. Dissertation: Persistent symptoms attributed to Lyme disease and their antibiotic treatment. Results from the PLEASE study. 2019.

Commentary on the Berende trial

The Fallon Trial 🇺🇸

Fallon BA, et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology. 2008;70(13):992-1003.

Commentary on the Fallon trial:

Neurology Today: New Study Reports Short-term Benefits But Not Sustained Improvement in Cognition With Prolonged Antibiotic Use for Lyme Disease Encephalopathy

The Oksi Trial 🇫🇮

Oksi J, et al. Duration of antibiotic treatment in disseminated Lyme borreliosis: a double-blind, randomized, placebo-controlled, multicenter clinical study. Eur J Clin Microbiol Infect Dis. 2007;26(8):571-81.

The Krupp Trial 🇺🇸

Krupp LB, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology. 2003;60(12):1923-30.

Kaplan RF, et al. Cognitive function in post-treatment Lyme disease: do additional antibiotics help? Neurology. 2003;60(12):1916-22.

Commentary on the Krupp trial

The Two Klempner Trials 🇺🇸

Klempner MS, et al. Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med. 2001;345(2):85-92. [Two trials published together]

Other studies

Of course, there are also a number of additional studies that support the scientific consensus that long term antibiotics for Lyme disease are not justified.

For example, an RCT by Dattwyler and colleagues randomized patients with late Lyme disease to receive either 14 days of intravenous antibiotics (n=80) or 28 days of intravenous antibiotics (n=63). There were 5 treatment failures in the 14 day group and 0 treatment failures in the 28 day group.

A 1999 study by Carlson and colleagues found no evidence of Borrelia Burgdorferi DNA in knee tissue samples from 26 patients with post-antibiotic Lyme arthritis.

A 2019 study by Dr. Brandon Jutras, Dr. Robert Lochhead, and others found that part of bacteria cell wall called peptidoglycan may trigger an inflammatory reaction that results in persistent Lyme arthritis.

Also in 2019, Grillon and other researchers from France found post-antibiotic Lyme arthritis could be cured using DMARDs.

Below is a video of Dr. Lochhead discussing their group’s findings:

Citations

Dattwyler RJ, et al. A comparison of two treatment regimens of ceftriaxone in late Lyme disease. Wien Klin Wochenschr. 2005; 117(11-12):393–7.

Carlson D, et al. Lack of Borrelia burgdorferi DNA in synovial samples from patients with antibiotic treatment-resistant Lyme arthritis. Arthritis Rheum. 1999;42(12):2705-9.

Jutras BL, et al. Borrelia burgdorferi peptidoglycan is a persistent antigen in patients with Lyme arthritis. Proc Natl Acad Sci USA. 2019;116(27):13498-13507.

Grillon A, et al. Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis. Semin Arthritis Rheum. 2019;48(6):1105-1112.

Discussion by scientists

NIH: Lyme Disease Antibiotic Treatment Research

NIH: Chronic Lyme Disease

NIH National Center for Complementary and Integrative Health: Lyme Disease

CDC: Dangers of long-term or alternative treatments for Lyme disease

CDC: Alternative treatments for Lyme disease

CDC: Serious Bacterial Infections Acquired During Treatment of Patients Given a Diagnosis of Chronic Lyme Disease — United States

Klempner MS, et al. Treatment trials for post-Lyme disease symptoms revisited. Am J Med. 2013;126(8):665-9.

Auwaerter PG. Point: Antibiotic therapy is not the answer for patients with persisting symptoms attributable to lyme disease. Clin Infect Dis. 2007;45(2):143-8.

Melia MT, Auwaerter PG. Time for a Different Approach to Lyme Disease and Long-Term Symptoms. N Engl J Med. 2016;374(13):1277-8. [paper mirror]

Oliveira CR, Shapiro ED. Update on persistent symptoms associated with Lyme disease. Curr Opin Pediatr. 2015;27(1):100-4. [video commentary]

See statements from medical societies in our Scientific Consensus section.