Intended for healthcare professionals

Editorials

Lyme disease: time for a new approach?

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6520 (Published 03 December 2015) Cite this as: BMJ 2015;351:h6520

Re: Lyme disease: time for a new approach?

Dr Matthew Dryden's much "liked" contribution eloquently displays the need for a more open-minded approach to Lyme Borreliosis. He says that "most" of those with objective clinical signs and positive serology "recover with short course antibiotics". It is far from certain that this is the case. What does he mean by "most"? What does he mean by "short course antibiotics"? What does he mean by "recover"? Regrettably the true, total, number of cases is unknown and therefore we have no measure for "most". Is he talking about 14 days of Doxycycline at 100mg twice a day? In cases where there is clear recent infection (i.e. supported by current Erythema Migrans) and not complicated by other tick-borne pathogens, such treatment MAY be successful. For those patients who are diagnosed long after infection, for whatever reason, the outcomes are much less certain but there is plenty of empirical evidence from patients, and more open-minded GPs, that other treatments may be necessary. If we measure "recovery" as return to full health, even this is questionable. Whether due to continuing infection, re-infection, long-term damage to tissue and nervous systems, or the undoubted psychological damage caused by this illness, we don't know how many patients truly "recover" and return to full health and how many of those still unwell remain with active infection.

There are contrary views to those of Dr Dryden. The major problem with professionals of his standing making blanket assertions is that he persuades others of certainty where, actually, there is precious little. Please keep an open mind.

Competing interests: No competing interests

01 February 2016
Andrew Gold
Retired Architect
None
Seaton, Devon