ME/CFS in the Department of Medicine

Tick-Borne Diseases

Treatment Options

From Fallon et al. "A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy."

Optimal treatment remains uncertain for patients with cognitive impairment that persists or returns after standard IV antibiotic therapy for Lyme disease. Brian Fallon, MD studied 37 patients who had well-documented Lyme disease, with at least 3 weeks of prior IV antibiotics, current positive IgG Western blot, and objective memory impairment. Enrolled patients had mild to moderate cognitive impairment and marked levels of fatigue, pain, and impaired physical functioning. 20 healthy individuals served as controls for practice effects. Patients were randomly assigned to 10 weeks of double-masked treatment with IV ceftriaxone or IV placebo and then no antibiotic therapy. The primary outcome was neurocognitive performance at week 12-specifically, memory. Durability of benefit was evaluated at week 24.

Across six cognitive domains, a significant treatment-by-time interaction favored the antibiotic-treated group at week 12. The improvement was generalized (not specific to domain) and moderate in magnitude, but it was not sustained to week 24. On secondary outcome, patients with more severe fatigue, pain, and impaired physical functioning who received antibiotics were improved at week 12, and this was sustained to week 24 for pain and physical functioning. Adverse events from either the study medication or the PICC line were noted among 6 of 23 (26.1%) patients given IV ceftriaxone and among 1 of 14 (7.1%) patients given IV placebo; these resolved without permanent injury.

Fallon’s group concluded that IV ceftriaxone therapy results in short-term cognitive improvement for patients with posttreatment Lyme encephalopathy, but relapse in cognition occurs after the antibiotic is discontinued.1

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CITATION

1 Fallon et al. "A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy." Neurology. 2008 Mar 25;70(13):992-1003. Epub 2007 Oct 10. http://www.ncbi.nlm.nih.gov/pubmed/17928580

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