Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
For patients treated for Lyme disease, most individuals recover completely, though it may take time for their symptoms to continue improving in the months following antibiotic treatment NICE CKS. Patients should be advised to contact their doctor if their symptoms have not improved or if symptoms return after completing treatment NICE CKS.
Monitoring for Persistent Symptoms and Complications:
- Regular Clinical Review: People with ongoing symptoms, including those without a confirmed diagnosis, should be offered regular clinical review and reassessment NICE NG95.
- Addressing Specific Symptoms: Explore any ongoing symptoms with the person and offer additional treatment as needed, following usual clinical practice NICE NG95. Be alert to the possibility of symptoms related to Lyme disease that may require assessment and management, such as chronic pain, depression and anxiety, fatigue, and sleep disturbance NICE CKS,NICE NG95.
- Non-Antibiotic Management: Support individuals with ongoing symptoms by encouraging and helping them access additional services, including referral to adult social care for a care and support needs assessment if beneficial NICE NG95. Communication with children and families' social care, schools, higher education, and employers may be necessary regarding a gradual return to activities NICE NG95.
- Re-evaluation of Treatment: If symptoms persist after treatment, review the person's history and symptoms to explore possible alternative causes NICE CKS. If re-infection is suspected based on the person's history, offer antibiotic treatment NICE CKS.
- Second Course of Antibiotics: A second course of antibiotics may be considered for people with ongoing symptoms if treatment may have failed, using an alternative antibiotic to the initial course NICE CKS,NICE NG95. For example, for adults with Lyme disease and arthritis, amoxicillin could be offered if doxycycline was the initial course NICE NG95.
- Specialist Referral: If symptoms persist despite two completed courses of antibiotics, further antibiotics should not be routinely offered NICE CKS,NICE NG95. Instead, consider discussion with a national reference laboratory or discussion/referral to a specialist NICE CKS,NICE NG95.
- Patient Education: Explain to people with ongoing symptoms that continuing symptoms may not mean they still have an active infection, and symptoms of Lyme disease can take months or years to resolve even after treatment NICE CKS,NICE NG95. Some symptoms may be a consequence of permanent damage from the infection, and there is no test to assess for active infection NICE CKS,NICE NG95. It is also important to explain that infection does not provide lifelong immunity, and re-infection is possible NICE CKS. Advise on how to minimise the risk of being bitten by a tick again, including checking clothing and exposed skin, covering up, and using insect repellents NICE CKS.
- Jarisch-Herxheimer Reaction: Inform patients that a Jarisch-Herxheimer reaction, causing a worsening of symptoms early in treatment, can occur when large numbers of bacteria are killed NICE CKS. This reaction is usually self-limiting and does not typically warrant stopping antibiotics unless there is evidence of a severe allergic reaction NICE CKS.