In this week's Annals of Internal Medicine is an excellent paper on the treatment of Lyme Disease. It's a randomized controlled trial:
Extending treatment with doxycycline from 10 to 20 days or adding one dose of ceftriaxone to the beginning of a 10-day course of doxycycline did not enhance therapeutic efficacy in patients with erythema migrans. Regardless of regimen, objective evidence of treatment failure was extremely rare.
Here in upstate New York, we see lots of lyme disease. I keep meaning to write up the patient I cared for who had flipped T-waves from Lyme disease. (another story of the family physician saving the day by seeing the forest for the trees .. whilst the cardologists scratched their chins) ..
Anyway … we do see lots of it. And there is a lot of misdiagnosis too.
So a shorter course for everyone is better.
There's a patient handout that comes with the article. Well done!