The antibiotic debate

The conservative line is that Lyme disease is easily treated with three or four weeks of antibiotics. After this time, the patient is pronounced 'cured'. Many physicians, however, withhold antibiotic treatment until a blood or urine test confirms the presence of antibodies to

B. burgdorferi.

However, for short term antibiotic treatment to be successful, it must be initiated immediately certainly no more than six weeks after the tick bite. And tested early after a bite, the body is unlikely to show antibodies to the spirochaetes thus, the patient is unlikely to receive the necessary urgent treatment.

Because of this, the very patients who are unable to generate detectable levels of free antibodies, whose immune systems are least able to deal with the infection and who may present with more serious illness among those infected are least likely to be offered treatment (J Clin Microbiol, 1993; 31: 1961-3). After six weeks, up to 95 per cent of patients may have antibodies to B. burgdorferi but, by then, antibiotic treatment is unlikely to be effective.

Some specialists among them, Dr Joseph J. Burrascano, Jr believe that the only way to treat chronic or severe Lyme disease is with long term antibiotics. Dr Burrascano is an international expert on Lyme disease, whose Diagnostic Hints and Treatment Guidelines for Lyme and Other Tick Borne Illnesses (available at www.lymenet.com), in its 13th edition, is now a standard text on the subject.

He has treated more than 7000 Lyme patients over the last 15 years.

Dr Burrascano advocates long term antibiotic treatment especially for intractable cases which can, in rare circumstances, last for years. For this reason, he is currently being prosecuted by the New York Office of Professional Medical Conduct (OPMC) as such a practice flies in the face of the medical partyline, which states that Lyme disease is easily cured with short term antibiotic treatment. Another 50 physicians in several different states are also currently under investigation for sharing views similar to Dr Burrascano's.

The charges against Dr Burrascano were not brought about by patients, but by the OPMC which, after raiding his offices, selected the files of nine patients as evidence of failing to treat patients properly. The patients deny the charges and claim Dr Burrascano has brought them back to health in some cases, after long periods of suffering.

Rheumatologist Dr Allen Steere, credited with discovering and naming the disease, is an advisor to the American Lyme Disease Foundation (ALDF). His conservative practice guidelines for the treatment of Lyme disease are widely accepted by the majority of doctors and by official agencies such as the Centers for Disease Control (CDC) and the NIH.

Dr Steere often provides testimony against physicians who do not follow his guidelines. In 1993, he and his colleagues went so far as to suggest that Lyme disease was "overdiagnosed and overtreated" which has since become his mantra (J Am Med Assoc, 1993; 269: 1812-6). They claimed, among other things, that the reason so many patients failed to respond to antibiotic treatment was that they were either not ill in the first place or had been misdiagnosed.

Dr Steere and company came to this conclusion using a new serological test of their own design, which showed that 98 per cent of patients with active Lyme disease tested as seropositive whereas, of those who had never had the disease but were evaluated because of suspected Lyme disease, none was seropositive. The most remarkable thing about this claim was that it indicated that they had come up with a testing protocol that was vastly superior to any other in existence. That no seronegative patients were found in their study, however, is contrary to all that is known about seronegative culture positive cases.