5 April 2016

Michael Woodhead

It is unethical to offer long-term antibiotics for Lyme disease symptoms, says an infectious disease expert.

Professor Peter Collignon, professor of microbiology at the Australian National University in Canberra, says a new randomised controlled trial has shown that antibiotics offer no benefit and may cause significant harm.

The findings come as a Senate Inquiry into the treatment of Lyme disease in Australia announced it had received 400 submissions, with many individuals claiming they have had the infection and calling for wider access to treatments, such as long-term antibiotics.

typical bullseye rash of Lyme disease
Typical bullseye rash of Lyme disease.

However the Dutch study, published in the New England Journal of Medicine, concluded that 12-week courses of drugs, such as doxycycline or clarithromycin, are no better than placebo (dummy treatment) in treating the persistent non-specific symptoms attributed to Lyme disease.

The trial included 280 patients with fatigue, muscle and joint, or neuropsychological symptoms associated with positive Lyme disease tests who were treated with intravenous ceftriaxone for two weeks then allocated to receive a 12-week oral course of either doxycycline, clarithromycin–hydroxychloroquine or placebo.

During follow-up of almost 40 weeks, there was no difference in symptoms or health-related quality of life between the antibiotic and placebo groups, with all patients showing some improvement over time.

The findings confirmed those of smaller studies from the US, which showed that longer courses of antibiotics have no additional benefit over initial antibiotic treatment for Lyme disease symptoms, said Professor Collignon.

“What this shows is that, even in an area with confirmed Lyme disease, this [prolonged antibiotic] treatment didn’t make any difference to patients,” he told Australian Doctor.

Professor Collignon said he treated patients with confirmed Lyme disease acquired overseas with 2-4 weeks of doxycycline and that he also offered antibiotics to patients with Lyme-like symptoms because ticks might harbour as yet unidentified bacteria.

However, as well as being ineffective, longer courses of intravenous antibiotics exposed patients to the risks of side effects, clotting and catheter sepsis, as well as promoting antibiotic resistance, he said.

The Senate inquiry, which is due to report in late June, has received unanimous advice from medical groups, such as the Australian Medical Association, that there is no evidence to support the presence of Lyme disease in Australia and no evidence to back the long-term use of antibiotics.

Last Reviewed: 05/04/2016

Australian Doctor


1. NEJM 2016; 374:1209-1220.
2. Senate inquiry into Lyme-like illness