Treatments

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A word about the treatments

* Warning: The information presented on the AQML website is not intended to be a self-care treatment plan. The AQML simply presents the various treatment options available, in order to help you and your doctor determine the treatment plan best suited to your personal situation.

Treatments for Lyme disease are highly complex and vary greatly from one person to the next. Factors influencing treatment include: The stage of the disease, the presence of co-infections complicating the clinical situation, but mainly the patient’s state of health (which is unique to each individual).

To this day, no ideal treatment regimen is certain to eradicate the bacterium. Generally, the sooner the infection is treated, the better the chances of remission. It is therefore advisable to take action as early as possible to avoid chronic damage.

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INESSS recommendations

  • In a patient with skin involvement and no other symptoms suggestive of the disseminated stage: Should there be any doubt between a diagnosis of infectious cellulitis and erythema migrans of Lyme disease, treatment with antibiotics covering both conditions should be recommended (eg. cefuroxime axetil).
  • Upon diagnosis of isolated erythema migrans, antibiotic treatment can be started immediately (serological tests are not indicated in this case).
  • After diagnosing Lyme disease involvement (e.g. isolated erythema migrans), the physician should always examine for the presence of symptoms and signs of involvement elsewhere, in order to determine the appropriate antibiotic treatment.
  • Depending on the clinical picture, antibiotic therapy may be initiated in situations where neurological, cutaneous (multiple erythema migrans), heart or joint disorders are suspected to be due to Lyme disease, while awaiting the laboratory results, after consultation with one or more specialists or an experienced colleague.
  • Doxycycline and beta lactams are the preferred treatments for the various manifestations of Lyme disease. Where these molecules cannot be prescribed (e.g. absolute contraindication, very severe allergic reaction to penicillin), macrolides can be used to treat isolated erythema migrans. In the case of other clinical manifestations, the antibiotic choice should be discussed with a specialist.

Here are the detailed INESSS recommendations:

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ILADS recommendations

In all tick bite cases, with or without redness or erythema migrans, the AQML supports the ILADS (International Lyme and Associated Diseases Society) recommendations, which give you three options:

Immediately seek preventive antibiotic treatment (prophylaxis) in the event that the tick that bit you was infected. Should you develop symptoms, a complete treatment lasting several weeks is required.

Allow 30 days to pass, and keep an eye on your general health by monitoring your symptoms. If you start to feel ill and develop any symptoms of the disease, require antibiotic treatment for several weeks.

Wait six weeks and ask your doctor for an ELISA test.

Arm of a person with an intravenous (IV) line.

In the event that the infection continues beyond treatment, and the patient develops arthritic, neurological or cardiac symptoms associated with Lyme disease, the administration of an intravenous antibiotic is often recommended. To prevent further infection, it is advisable to act as quickly as possible.

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The current ILADS recommendations are as follows

  • ILADS advises against the use of a single 200 mg dose of doxycycline for the prevention of Lyme disease Besides being highly unlikely to be effective, treatment failure in the human trial led to a sero-negative disease state.

  • Based on animal studies, ILADS recommends that known blacklegged tick bites should be treated with 20 days of doxycycline (unless contraindicated).

  • Given the low success rates of trials treating EM rash for 20 days or less, ILADS recommends that patients receive 4 to 6 weeks of doxycycline, amoxicillin or cefuroxime. In Europe, a minimum of 21 days of azithromycin is also acceptable.

  • Every patient should be re-evaluated at the end of their initial treatment and, if necessary, antibiotic treatment should be extended.

  • The ILADS recommends that patients with persistent symptoms and signs of Lyme disease should be evaluated for other potential causes before additional antibiotic treatment is initiated.

  • The ILADS recommends antibiotic re-treatment when chronic Lyme infection is deemed a possible cause of persistent manifestations and the patient’s quality of life is impaired.

Importantly, in all cases: given the sheer number of clinical variables involved and the heterogeneity within the patient population, clinical judgment is crucial to patient-centred care.

Based on the GRADE model, the ILADS team recommends that patients’ goals and values concerning treatment options be identified and strongly acknowledged in a shared decision-making process.

With our personal experiences with Lyme sufferers, the AQML has supported the views of ILADS.

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Treatment in the advanced phase (early and late dissemination):

Treatment and diagnosis of more advanced forms of Lyme disease, where the infection has been ongoing for months or even years, can be much more complex.

People with Lyme disease may remain asymptomatic for months or years before the disease manifests itself (usually as a result of stress weakening the immune system). Symptoms can be disabling and may require aggressive treatment. A major controversy remains as to:

The very existence of the chronic form of Lyme disease.

Its treatment, if it is recognized.

Many patients with the chronic form will therefore turn to specialists. Treatment options vary greatly from one individual to another. These include:

Extended oral antibiotic therapy

Extended IV antibiotic therapy

Natural herbal antimicrobial treatments such as the Buhner protocol or Cowden protocol.

Alternative treatments outside the country, such as: Ozone therapy, SOT therapy, therapeutic aphaeresis, stem cells and much more.

Many Lyme patients with this form will turn to doctors known as LLMDs or Lyme literate doctors:

An LLMD is a doctor whose experience with Lyme disease patients makes them familiar with the wide range of symptoms, co-infections and complications associated with the disease. LLMDs are ILADS-accredited, having attended numerous international training courses and congresses. Given their knowledge and expertise in the disease, they will generally be characterized by understanding and empathy. Among other things, this is due to their experience in caring for patients with the condition. To find an LLMD, please refer to the following links:

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