I had a conversation with a patient this week where our decision was to watch and wait. He had a bulls eye rash in late summer, and was very early on treated with first cephalexin for suspected skin infection, then doxycycline 200 mg twice a day (higher dose) for lyme. This was early treatment. The patient was symptomatic with headaches, blurred vision, stiff neck, flu like symptoms.
There were still symptoms at the end of 3 weeks, and the family MD after a week off antibiotics extended for 6 weeks. The patient was still symptomatic despite early treatment.
He then came to see me for a second opinion, as he had already started on 3 months of clarithromycin and hydroxychloroquine. To our delight, after 3 months the patient was mostly symptom free.
The interesting thing about this case is that there was very early treatment, which was not successful. Despite that, relatively simple treatment, which was probiotics and antibiotics, was able to finally clear the symptoms. Often if simple treatment with doxycycline is not effective, we have to consider more aggressive treatment that covers for all forms or morphologies of lyme is needed, or a lot of supportive measures for hormones, detoxification, nutrition is needed. In this case, switching classes of medication and adding in something for the cyst form of lyme seemed to be most useful.