Cost-eff of longer versus short-term provision of monotherapy (with one antibiotic) for chronic lyme

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Date Joined Feb 2015
Total Posts : 1527
   Posted 4/30/2018 3:40 AM (GMT -6)   
Cost-effectiveness of longer-term versus shorter-term provision of antibiotics in patients with persistent symptoms attributed to Lyme disease
Published: April 2, 2018

Authors: Anneleen Berende , Lisette Nieuwenhuis, Hadewych J. M. ter Hofstede, Fidel J. Vos, Michiel L. Vogelaar, Mirjam Tromp, Henriët van Middendorp, A. Rogier T. Donders, Andrea W. M. Evers, Bart Jan Kullberg, Eddy M. M. Adang (all authors are from the Netherlands)


So the idea is they took some lyme patients, treat them all with 2 weeks of ceftriaxone (rocephin)

Next they split the treated ceftriaxone patients in 3 groups

  • group 1 received 12 more weeks of doxy

  • group 2 received 12 more weeks of clarithromycin + hydroxychloroquine. This is not considered "treatment with two antibiotics", plaquenil (hydroxychloroquine) here just augments the effects of clarithromycin in low pH environments (inside cells).

  • group 3 received placebo

The longer-term treatments were similar with regard to costs, effectiveness and cost-effectiveness compared to shorter-term treatment in patients with borreliosis-attributed persistent symptoms after one year of follow-up. Given the results of this study, and taking into account the external costs associated with antibiotic resistance, the shorter-term treatment is the antibiotic regimen of first choice."

I think this study (it is a fork of the larger "PLEASE" study done in the Netherlands) is good because it shows taking one antibiotic at a time is really bad idea and you can very well just do nothing and save the money (although even so there is no really big change in terms of $$).

You either do combination therapy (3-4 antibiotics AT THE SAME TIME) for which we know clinically from people on this forum and LLMDs there is improvement but there are no double blind placebo trials at all, or you just don't take anything and try to eat healthy, drink plenty of fresh water exercise (if u can) etc.... Maybe take some pain and sleep meds.

So DO NOT treat with mono-therapy (one single antibiotic) for months, it DOES NOT WORK.

PS: I wonder when will the medical community do really useful lyme placebo controlled trials!? Since tens of thousands of us patients are treated by LLMDs with more than one antibiotic, what is the usefulness of such study, testing just one antibiotic on people for 12 weeks !?

Is there anyone reading this post that gets long term treatment with just one antibiotic ? If so then please find a better LLMD, you will not get well like this...

Veteran Member

Date Joined Jun 2017
Total Posts : 518
   Posted 4/30/2018 6:55 AM (GMT -6)   
True. I went to a "bargain" LLMD and treated May-August of last year with doxy and got much worse afterward. Now doing better with a combination.
"This too shall pass. It might pass like a kidney stone, but it will pass."

Lyme, babesia, mycoplasma pneumonia. Diagnosed May 2017. Neuro symptoms began September 2017. Treating 11 months so far.

Regular Member

Date Joined Sep 2017
Total Posts : 397
   Posted 4/30/2018 8:28 AM (GMT -6)   
My LLMD rotates courses of antibiotics. Typically 30 day courses. Some courses are monotherapy. Some are not. I have done well so far in 8 months of treatment.

The good thing about a regimen like that, is you can clearly examine your reaction to each med. There is no question of what is causing improvements or herxes.

The downside- I did waste one month on Zithromax and one month on Doxycycline monotherapy. Each of those months I saw my symptoms creeping back in.

Veteran Member

Date Joined Jul 2016
Total Posts : 1353
   Posted 4/30/2018 2:31 PM (GMT -6)   
Just want to emphasize this only applies to treated lyme. Monotherapy early on can absolutely be effective. My wife just started getting sick from a tick bite and it totally cleared with doxy. But yeah... I'm not shocked that these trials fail to show benefit with late lyme given that the drugs of choice do not reflect the current understandings of persister biology or any of the features which are believed to be relevant to chronic infections

Forum Moderator

Date Joined May 2014
Total Posts : 33957
   Posted 4/30/2018 4:32 PM (GMT -6)   
As Psilo stated - acute/early infection is usually treated with one antibiotic but not chronic / late stage Lyme.

I think it’s common knowledge with LLMD’s to not do one antibiotic for chronic Lyme.

If they do prescribe just one - I wouldn’t consider them Lyme Literate, really.
Moderator, Lyme Forum
Symp started April/2013; Buhner's Lyme May 15-July24/14; Igenex pos. July 3/14
Doxy: July 4-Aug.24/14;Zithro July26-Aug24/14; Amox + Proben. Aug. 29/14;
added biaxin Sept. 26/14
Disc. amox,added Ceftin Nov. 20th.;
Disc. biaxin added Buhner bart herbs Dec/14;Jan/15 pulsing Tinda (w/ Ceftin);
Abx/herb break Apr-July/15; July-mino; Aug. added Rif;
Nov./15 mino - to biaxi
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