There are two main factions in the Lyme disease (LD) treatment wars: the IDSA (Infectious Diseases Society of America) vs the ILADS (International Lyme and Associated Diseases Society).

The IDSA claims that LD is primarily a short-term disease for which a short course of antibiotics is usually all that is necessary. The ILADS disagrees. Its members say that LD is a chronic, potentially recurring disease, and may need many months or even years of treatment with a cocktail of antibiotics.

A French review of the evidence showed that antibiotics are effective in 90 per cent of cases (Med Mal Infect, 2007; April 3; Epub ahead of print), lending support to the IDSA position.

However, two studies by Dr Mark Klempner and his colleagues at Tufts University in Boston, MA, have shown that even intensive antibiotic therapy for 90 days may not work in cases where LD symptoms persist despite treatment (N Engl J Med, 2001; 345: 85–92), lending support to the ILADS. “Profound fatigue, myalgias, arthralgias, dysaesthesia, and mood and memory disturbances still persist after standard courses of antibiotic treatment for LD,” he says.

ILADS practitioners, therefore, usually take a more holistic approach, combining antibiotics with botanical remedies, nutritional supplements, diet, detoxification and homeopathy.

A vaccine called Lymerix was marketed in 1998, but withdrawn four years later. GlaxoSmithKline, the manufacturers, blamed poor sales and the need for frequent boosters. Patients cited the high pricetag and side-effects, including severe arthritis and even LD itself, problems which resulted in a class-action lawsuit.

The main reason why Lyme disease is so difficult to treat may be because the causal bacteria are so wily. Borrelia has been called “one of the most complex bacteria known to man” (Chemotherapy, 2006; 52: 53–9). A further confounding factor is that Borrelia burgdorferi is rarely the only invader. Most LD patients are also found to be infected with multiple tick-borne pathogens, such as protozoans and other parasites.