Still Not Out Of The Woods

Most people who develop Lyme Disease, a tick-borne infection that's endemic in parts of the Northeast and Midwest, are easily cured by taking an antibiotic like doxycycline for a couple of weeks. But for years a debate has raged over what to do about patients whose symptoms (fatigue, mental confusion, joint pain) never seem to clear up. One small but vocal group of doctors and patient advocates believes that Lyme's corkscrew-shaped spirochetes have burrowed deep into their victims' bodies and can be eradicated only with intensive antibiotic treatment over many months. Another group believes, just as adamantly, that the bacteria are long gone, making further treatment with powerful antibiotics--which can lead to potentially fatal infections or blood clots--positively dangerous.

Now comes word of two studies in the New England Journal of Medicine that show that long-term antibiotic treatment is no better than a placebo for folks with chronic Lyme disease. Originally scheduled for publication in July, the research is part of a group of findings made public in early June--just in time for the peak Lyme months of June and July. If confirmed by another major study that's looking at chronic Lyme and antibiotics from a slightly different perspective, the results would seem to settle the question once and for all.

Researchers from Boston, New Haven, Conn., and Valhalla, N.Y., followed 129 patients who had previously been treated for well-documented cases of Lyme disease. Sixty-four were given antibiotics directly into their veins for a month, followed by two months of oral antibiotics. The others received dummy medications. A third of the chronic Lyme patients got better while taking the antibiotics, but so did a third of those on the placebo. Indeed, the results were so similar that a monitoring board decided to cut the trials short rather than add more subjects to the test groups.

Unfortunately, the debate over chronic Lyme has become so heated that no one expects the controversy to go away. But both sides may take comfort in the other findings that were released by the New England Journal last week. After studying 482 subjects bitten by deer ticks in a part of New York with a lot of Lyme disease, researchers concluded that a single 200-mg dose of doxycycline dramatically cut the risk of contracting the disease. That good news is tempered somewhat by the fact that 80% of patients who develop the infection don't remember ever being bitten by a tick. (The bugs inject an anesthetic into the skin to mask the pain and in their nymph stage are so small--about the size of a poppy seed--that they are easily overlooked.)

There's still plenty you can do to protect yourself in a Lyme-infested neighborhood: tuck your pants in your socks, spray DEET on your clothing, check yourself and your kids for ticks. And if you develop a spreading red rash--particularly if it's accompanied by joint pain, chills or confusion--make sure you see a doctor right away. The trick, as always, is to be vigilant without overreacting.