Once upon a time...

The most recent study of 'long-term' antibiotics on chronic Lyme was just published in Neurology. The study took a group of previously treated Lyme patients (with positive Western blots at the time of study entry) and did a randomized, placebo-controlled trial of IV ceftriaxone. One group received 10 weeks of IV ceftriaxone, and one group received 10 weeks of an IV placebo. There was also a group of health controls evaluated and tested at the same time as the Lyme groups to control for the practice effect on neuropsychological testing. A notable percentage of those on ceftriaxone showed meaningful improvement in fatigue, cognitive function, pain, and the degree of physical impairment compared to the placebo group. However, when the researchers examined the groups again 12 weeks after the antibiotic had been stopped, the improvements were no longer seen.

What are 'they' ('They' being the IDSA and other like minded doctors, notably NOT including the study's author) concluding from this study? Here's the response from Dr. Halperin, one of the doctors on the committee that drafted the IDSA guildlines for treating Lyme.

Prolonged Lyme disease treatment: Enough is Enough
John J. Halperin, MD

Diseases have histories. Lyme disease, infection with the tick-borne spirochete Borrelia burgdorferi, acquired its identity and name when mothers of affected children pressed it into medical consciousness. The disease has continued to have an
articulate, populist constituency, ardently advocating for enhanced recognition and treatment. Tension has resulted when scientific fact has diverged from advocates' beliefs.

Particular controversy concerns patients with chronic symptoms, including cognitive and memory impairment, attributed by some to persisting infection with B burgdorferi despite previous treatment with usually effective antimicrobials. Proponents recommend many months-long courses of antimicrobials. In contrast, panels of the Infectious Diseases Society of America and the American Academy of Neurology have concluded that Lyme disease is treated effectively with several weeks of antibiotics. (Since these publications, an additional European study has similarly found that prolonging treatment of disseminated Lyme provides no additional benefit.) The guidelines have met with advocates' ire---and
with subpoenas from the Connecticut Attorney General, contending that such recommendations
constitute unlawful restraint of trade.

In this issue of Neurology®, Fallon et al. address the core of this controversy. Thirty-seven patients with prolonged cognitive and other symptoms after treated Lyme disease were randomly assigned to double-blinded treatment with 10 weeks of IV ceftriaxone or placebo. The subjects were reevaluated 12 weeks after starting treatment, and again 12 weeks later. Treatment resulted in no sustained benefit.

Read the rest of the article at
http://www.neurology.org/cgi/rapidpdf/01.WNL.0000291407.40667.69v1.pdf . They are concluding that this shows that 'long term' antibiotics offer no sustainable benefits to patients with CNS symptoms from Lyme.

HOW?!?!

To me, it seems to show that the antibiotics did something. Perhaps we should leave the pateints on them for longer than 10 weeks to see if the results would then be sustainable? You know, maybe for the length of time that LLMD (Lyme-literate medical doctors) typically use and report success with?

They are doctors! I thought they were supposed to be intelligent.