Duration and frequency of antibiotics to treat tick diseases such as Lyme, is fueling a debate.
The Centers for Disease Control and Prevention (CDC) reports 10 percent to 20 percent of patients treated for Lyme disease with antibiotics for two to four weeks have lingering symptoms — fatigue, pain, join and muscle aches.
It’s a subject that have some calling it “chronic Lyme disease.” The CDC calls it post-treatment Lyme disease syndrome (PTLDS).
The exact cause is unknown, the CDC reports, adding most medical experts believe lingering symptoms are related to damage to tissues during the infection. Dr. Elizabeth Maloney, affiliated with the Minnesota Lyme Association, said patients can be frustrated with long-term effects from Lyme disease and feel marginalized by the medical community.
Lyme disease is a potentially serious bacterial infection transmitted from blacklegged ticks. Co-infections with other tick-borne diseases can make the illnesses more severe.
“Recent animal studies have given rise to questions that require further research, and clinical studies to determine the cause of PTLDS in humans are ongoing,” the CDC reported. “Regardless of the cause of PTLDS, studies have not shown that patients who received prolonged courses of antibiotics do better in the long run than patients treated with placebo. Furthermore, long-term antibiotic treatment for Lyme disease has been association with serious complications. The good news is that patients with PTLDS almost always get better with time. The bad news is that it can take months to feel completely well.”
Maloney said the CDC’s posture change to even address the recent animal studies findings is big.
Maloney recommends a 10 to 20 day dose of 100 mg of doxycycline as a preventative measure for a tick bite. Maloney said her recommendation is based on animal studies with biopsies finding the disease persisted after treatment. Maloney said the argument of bacterial resistance to antibiotics was not a realistic concern compared to the debilitating disease posed by Lyme. She pointed to the common use of antibiotics in treatment for acne, which doesn’t spur the same debate or the use of antibiotics in animal feed.
“It’s not a trivial question,” Maloney said, adding she isn’t brushing it aside, but said it does make a difference what class of antibiotics is being discussed.
“Let’s keep it in perspective,” she said, adding the use of antibiotics in Lyme disease compared to the use of antibiotics in all disease is small. Every physician, Maloney said, comes to the issue with a bias or perspective.
“If I’m going to be wrong one way or the other, I’m going to be wrong on the side of over treatment,” Maloney said.
A family physician, Maloney said she began researching Lyme after a teenager she treated appeared to have her arthritis clear up but years later still had Lyme disease.
“It’s time to put aside the idea this is a simple infection,” Maloney said.
During a recent community health forum on tick-borne illnesses, Dr. Peter Henry, Essentia Health-St. Joseph’s Medical Center director of emergency medicine, touched on the treatment debate. “Overuse of antibiotics is an issue that has to be addressed,” Henry said.
Henry said staph organisms are becoming more resistant to antibiotics, making previously simple infections a dangerous even life-threatening concern. Henry said it is important to use antibiotics judiciously.
“Antibiotic resistance is a global health problem,” the Mayo Clinic reported. “Nearly all significant bacterial infections in the world are becoming resistant to commonly used antibiotics.”
Both Henry and the CDC acknowledged the frustration of people who still feel unwell long after treatment for Lyme. Maloney said those people feel marginalized or that their symptoms are not believed or not appreciated by health care professionals.
The Minnesota Department of Health reports the number of Lyme diseases cases has been “increasing dramatically, since the 1990s. Causes may be increased awareness by doctors in diagnosing the disease, increasing infection rates in ticks and more people in tick habitat.
The state health department reports from 1986 to 2010, nearly 15,000 cases of tick-borne diseases were reported in the state. Most, 12,084, were Lyme disease.
Even with the increasing number of cases of tick-borne illnesses, the Minnesota Department of Health notes most tick bites do not result in disease. All of Crow Wing, Cass, Aitkin, Morrison, Mille Lacs counties and parts of Todd County are considered high risk areas for tick-borne diseases in the state.