What follow-up care is necessary for patients treated for Lyme disease to monitor for potential complications or persistent symptoms?

For patients treated for Lyme disease, most individuals recover completely, though it may take time for their symptoms to continue improving in the months following antibiotic treatment ¹. Patients should be advised to contact their doctor if their symptoms have not improved or if symptoms return after completing treatment ¹.

Monitoring for Persistent Symptoms and Complications:

• Regular Clinical Review: People with ongoing symptoms, including those without a confirmed diagnosis, should be offered regular clinical review and reassessment ².
• Addressing Specific Symptoms: Explore any ongoing symptoms with the person and offer additional treatment as needed, following usual clinical practice ². Be alert to the possibility of symptoms related to Lyme disease that may require assessment and management, such as chronic pain, depression and anxiety, fatigue, and sleep disturbance ¹,².
• Non-Antibiotic Management: Support individuals with ongoing symptoms by encouraging and helping them access additional services, including referral to adult social care for a care and support needs assessment if beneficial ². Communication with children and families' social care, schools, higher education, and employers may be necessary regarding a gradual return to activities ².
• Re-evaluation of Treatment: If symptoms persist after treatment, review the person's history and symptoms to explore possible alternative causes ¹. If re-infection is suspected based on the person's history, offer antibiotic treatment ¹.
• Second Course of Antibiotics: A second course of antibiotics may be considered for people with ongoing symptoms if treatment may have failed, using an alternative antibiotic to the initial course ¹,². For example, for adults with Lyme disease and arthritis, amoxicillin could be offered if doxycycline was the initial course ².
• Specialist Referral: If symptoms persist despite two completed courses of antibiotics, further antibiotics should not be routinely offered ¹,². Instead, consider discussion with a national reference laboratory or discussion/referral to a specialist ¹,².
• Patient Education: Explain to people with ongoing symptoms that continuing symptoms may not mean they still have an active infection, and symptoms of Lyme disease can take months or years to resolve even after treatment ¹,². Some symptoms may be a consequence of permanent damage from the infection, and there is no test to assess for active infection ¹,². It is also important to explain that infection does not provide lifelong immunity, and re-infection is possible ¹. Advise on how to minimise the risk of being bitten by a tick again, including checking clothing and exposed skin, covering up, and using insect repellents ¹.
• Jarisch-Herxheimer Reaction: Inform patients that a Jarisch-Herxheimer reaction, causing a worsening of symptoms early in treatment, can occur when large numbers of bacteria are killed ¹. This reaction is usually self-limiting and does not typically warrant stopping antibiotics unless there is evidence of a severe allergic reaction ¹.