Posted 11 April 2016
Another study has confirmed the futility of long-term antibiotic therapy for people with symptoms attributed to “chronic Lyme disease.” This study involved 252 patients who received 2 weeks of standard antibiotic treatment followed by 12 weeks in which they received either doxycycline, another antibiotic, or a placebo. The three groups demonstrated no significant differences in outcome. 
An accompanying editorial concluded: “Patients with subjective, vexing symptoms attributed to Lyme disease should not anticipate that even longer courses of antibiotics will produce relief, a finding that is in concert with results from previous trials.” 
- Berende A and others. Randomized trial of longer-term therapy for symptoms attributed to Lyme disease. New England Journal of Medicine 2016;374:1277-1288.
- Melia TM, Auwaerter PG. Time for a different approach to Lyme disease and long-term symptoms. New England Journal of Medicine 2016;374:1277-1288.
[note note_color=”#fcf88a”]Chronic Lyme disease is a controversial diagnosis that encompasses “a broad array of illnesses or symptom complexes for which there is no reproducible or convincing scientific evidence of any relationship to B. burgdorferi infection.” There is no clinical evidence that “chronic” lyme disease is caused by a persistent infection. Most medical authorities advise against long-term antibiotic treatment for Lyme disease, though they agree that some patients do experience lingering symptoms. [Wikipedia][/note]
Another “Lyme literate” doctor disciplined
Despite the lack of evidence that long-term antibiotic therapy is useful against real or suspected Lyme disease, a small network of physicians who are commonly referred to as “Lyme literate” still administer it. Licensing boards generally frown on this practice but are unlikely to act without notification that a problem may exist. In 2015, the Maryland State Board of Physicians charged Daniel A. Jaller, M.D. with failing to meet the standard of care in his management of six patients whom he had treated for Lyme disease, bartoneliosis, and/or babesiosis without adequate evidence that they had these conditions. The statement of charges indicates that in 2013, the board was notified that Jaller had surrendered participation in an insurance program while being investigated for inappropriately treating patients. The board’s investigation concluded:
- Jaller’s diagnoses were based on negative or indeterminate blood tests and, in some cases, without objective evidence of infection (such as tick bites) in the patient’s history.
- Jaller diagnosed multiple chronic infections based mostly on subjective symptoms likely attributable to other diagnoses and consistently failed to consider alternative diagnoses.
- Jaller failed to refer patients to specialists to address severe symptoms of depression, neuropathy and/or chronic fatigue that he had documented.
- Based on his diagnoses of bacterial infections, Jaller prescribed antimicrobial treatment for months and often years, using as many as seven agents at a time and exposing patients to undue risks of complications of central venous catheter usage, adverse drug reactions, and increased resistance to the drugs.
The charges were settled with a consent order under which Jaller was reprimanded, ordered to take a course in medical documentation, and placed on probation for one year, during which he may be subject to chart and/or peer review.