Is retesting for Lyme disease necessary after completing a standard treatment course of antibiotics?

From the Guidelines

Retesting for Lyme disease after treatment is not recommended as it does not accurately indicate treatment failure or active infection. The 2021 clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) suggest that patients with persistent symptoms following standard treatment of Lyme disease should not receive additional antibiotics without objective evidence of reinfection or treatment failure 1. Key points to consider include:

• Persistent antibodies after treatment do not indicate active infection or treatment failure
• Clinical response to treatment, such as resolution of symptoms, is the primary indicator of successful therapy
• If symptoms persist or new symptoms develop after treatment, a clinical reassessment is warranted rather than repeat serologic testing
• Other diagnoses should be considered in cases of persistent or recurrent symptoms, as post-treatment Lyme disease syndrome can occur in approximately 10-20% of patients
• The decision to retreat should be based on clinical evidence of ongoing infection rather than serologic test results alone, as stated in the guidelines 1. Some specific scenarios where retesting or additional treatment may be considered include:
• Patients with Lyme arthritis who have a partial response to initial treatment, where a second course of oral antibiotics or IV ceftriaxone may be considered 1
• Patients with objective signs of disease activity, such as arthritis, meningitis, or neuropathy, which may indicate treatment failure or reinfection 1.

From the Research

Retesting for Lyme Disease After Treatment

• The necessity of retesting for Lyme disease after completing a standard treatment course of antibiotics is a topic of discussion among medical professionals 2, 3.
• According to a study published in the journal Infectious disease clinics of North America, most patients with Lyme disease will fully recover with recommended antibiotic therapy, and retesting may not be necessary for all patients 3.
• However, some patients may experience persistent symptoms after treatment, referred to as posttreatment Lyme disease symptoms (PTLDs) or syndrome (PTLDS), which may require further evaluation and potential retesting 2, 3.

Current Guidelines and Recommendations

• The current evidence suggests that prolonged antibiotic therapy provides little benefit and carries significant risk, and therefore, retesting and prolonged treatment may not be recommended for all patients 3.
• A study published in the journal BMC infectious diseases found that ceftriaxone may be an effective treatment option for post-treatment Lyme disease syndrome (PTLDS), but the results were based on a limited number of studies and more research is needed to confirm these findings 4.
• The diagnosis and treatment of Lyme disease are typically based on clinical presentation, and laboratory tests are used to support the diagnosis, but retesting after treatment may not be necessary in all cases 5, 6.

Considerations for Retesting

• Retesting for Lyme disease after treatment may be considered in certain situations, such as:
  • Persistent or recurrent symptoms
  • Incomplete response to treatment
  • New or worsening symptoms
• However, the decision to retest should be made on a case-by-case basis, taking into account the individual patient's clinical presentation and medical history 2, 3.
• More research is needed to fully understand the benefits and risks of retesting for Lyme disease after treatment, and to develop evidence-based guidelines for clinical practice 3, 4.