Many medical authors recommend treating all Lyme disease patients with 30 days of intravenous Rocephin. However, intravenous antibiotics may offer no advantage over less expensive pills (1). For many years I have been criticized for treating my Lyme disease patients who have muscle and joint pain and fatigue with 100 mg of minocycline or doxycycline twice a day for several months. You may need intravenous Rocephin for nerve damage if you have headaches, passing out, visual hearing or sensory disturbances or blood factors for Lyme disease in the spinal fluid.

After a tick bite, you may develop a large red spot, followed a few days later by a red ring around the spot, and the spots may disappear by themselves, or you may develop no spot at all. Several days or weeks later you may feel sick and think that you have the flu. Most authorities agree that taking doxycycline for 21 days will cure you. However, you may feel better with no treatment. Then many months later, you can develop symptoms such as joint or muscles pain or nerve damage. At this stage, you will probably require treatment with doxycycline for many months or even years (2), even if you take the intravenous Rocephin treatment.

Editors of the New England Journal of Medicine announced early release of studies showing that three months of antibiotics are not effective in curing people who have had Lyme disease and still suffer from muscle and joint pain, chronic fatigue, difficulty concentrating and many other vague and sundry signs and symptoms (3).

These studies show that there is no dependable way to define chronic fatigue syndrome or fibromyalgia. The authors did not treat Lyme disease, they treated a large group of people who suffered from what doctors call fibromyalgia or chronic fatigue syndrome. They treated 79 people with positive blood tests for Lyme disease and 51 who did not have positive blood test for Lyme disease. They showed that treating people with chronic fatigue syndrome or fibromyalgia for three months with antibiotics will not cure them.

Three months is not long enough to treat a person with reactive arthritis from any source. However, before a doctor is allowed to diagnose chronic fatigue syndrome or fibromyalgia or Lyme disease, he must rule out other diseases that can cause the same symptoms. There is little question that patients with hepatitis C can be treated successfully with interferon injections and that people with reactive arthritis can be treated successfully with antibiotics. However, people who have terrible fatigue and muscle and joint pain often cannot be cured by antibiotics.

Reactive arthritis patients who may be be cured by antibiotics are:

• Those who have positive blood tests for arthritis which are really measures of an overactive immunity that is trying to kill a germ,

• those who suffer from a chronic infection characterized by burning on urination, urgency or having to get up many times during the night

• those who have chronic diarrhea,

• those who have belching and burning in the stomach,

• those who have a chronic cough or sinus infections,

• those who have swelling in the middle of the hand which is characteristic of Rheumatoid arthritis.

The authors showed that three months of antibiotics does not cure fibromyalgia, chronic fatigue syndrome or presumed Lyme disease. However, people who have reactive arthritis must be treated for longer than three months, often for more than a year. We still do not know what chronic fatigue syndrome or fibromyalgia really are. Long term treatment with antibiotics is controversial and not accepted by most doctors; discuss your particular situation with your doctor.

1) NEJM, July 31, 1997.

2) ST Donta. Tetracycline therapy for chronic Lyme disease. Clinical Infectious Diseases 25: Suppl. 1 (JUL 1997):S52-S56. Address ST Donta, Boston Univ, Med Ctr, 88 E Newton St, Evans 6TH Floor, Boston, MA 02118 USA

3) NEJM, July 12, 2001

Checked 10/9/12