Prolonged Lyme disease treatment
Published Oct 10, 2007 · J. Halperin
Neurology
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Abstract
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.1 In contrast, panels of the Infectious Diseases Society of America2 and the American Academy of Neurology3 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 Lyme4 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.5 address the core of this controversy. Thirty-seven …