The treatment of early Lyme Disease has been examined in numerous well-documented studies. Largely because the diagnosis is easy to confirm when the erythema migrans (bull's eye or generalized) rash is present (documented that a large percent do not get the rash), the academic research community has focused its efforts on the treatment of early or acute Lyme Disease. Studies demonstrate that 4-6 weeks of oral antibiotics (doxycycline, cefuroxime, amoxicillin) results in remission and apparent cure in most but not all cases. Several months is not uncommon and a good outcome occurs in many only after several months.
Remember also to advise the patient of the likelihood of a Jarisch-Herxheimer (Herx) reaction upon initiation of treatment. This is common in spirochaetal disease treatment and is caused as a result of toxins released as the die off of the spirochetes takes place.
Treatment failures have proven time and again to benefit significantly from longer term antibiotic treatment and patients sometimes have to be very demanding to receive such treatment. In fact several states in the US have had to enact legislation to stop the nonsense put forward by the insurance/tourism lobby that a specific short term treatment cures Lyme disease. Studies that have been stopped at bias decided points (trying to establish results that they want to see), studies that have followed patients for very short time frames (when in fact longer term studies clearly show that 'cure' was sadly mistaken) have all been debunked by less influenced more legitimate researchers.
One has to be realistic...not being able to find something by available methods in science means nothing to the sick patient who recovers after many weeks/months of appropriate treatment.
Once the tick-borne spirochete, (Borrelia burgdorferi) has disseminated in the blood stream to other areas (such as the Central Nervous System or the joints), optimal dosing and duration of treatment is more uncertain. Although open label clinical reports suggest that repeated antibiotic therapy may be helpful, placebo-controlled studies of chronic Lyme disease are only now being conducted. In chronic Lyme disease, longer courses of treatment may result in a better long term improvement than shorter courses, but this has yet to be tested in a randomized scientific study. Co-infection with other tick-borne organisms, such as Babesia microti, may contribute to some of the persistent Lyme-like symptoms.
Manifestations of Lyme carditis include atrioventricular block, myopericarditis, intraventricular conduction disturbances, bundle branch block and congestive heart failure. Temporary cardiac pacing may be required in up to a third of cases and complete recovery occurs in most (greater than 90%) patients.