https://www.ncbi.nlm.nih.gov/pubmed/29477274

Diagn Microbiol Infect Dis. 2018 Feb 2. pii: S0732-8893(18)30042-7. doi: 10.1016/j.diagmicrobio.2018.01.025. [Epub ahead of print]

Is the risk of early neurologic Lyme borreliosis reduced by preferentially treating patients with erythema migrans with doxycycline?

Strle F1, Stupica D2, Bogovič P3, Visintainer P4, Wormser GP5.

Diagn Microbiol Infect Dis. 2018 Feb 2. pii: S0732-8893(18)30042-7. doi: 10.1016/j.diagmicrobio.2018.01.025. [Epub ahead of print]

Abstract
Doxycycline is highly effective treatment for early neurologic Lyme borreliosis (NLB). Nineteen studies were reviewed to determine if treatment of patients with erythema migrans with other oral antibiotics would increase the risk for developing NLB. In the eight studies that directly compared doxycycline to another antibiotic, the pooled difference indicated a 0.2% greater risk of developing NLB in doxycycline-treated patients (95% CI: -1.0%, +1.4%; P = 0.77), with an estimated heterogeneity of 0.0%, P = 0.58. Overall, in the 19 studies, NLB was reported in 8/828 (1.0%; 95% CI: 0.42%, 1.89%) doxycycline-treated patients versus 6/1022 (0.6%; 95% CI: 0.22%, 1.27%) patients treated with other antibiotics (P = 0.42). Based on the 95% CI calculation (-0.5%, +1.40%), patients receiving nondoxycycline treatment regimens collectively might have at most a 0.5% greater risk for developing NLB. Available data suggest that oral doxycycline is not superior to comparators for preventing NLB in patients receiving treatment for erythema migrans.

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**Comment**

I do not have access to the entire article but it would be interesting to know what the comparators were.

Of course NLB by definition means central nervous system involvement:  https://www.ninds.nih.gov/Disorders/All-Disorders/Neurological-Complications-Lyme-Disease-Information-Page.  As this link inaccurate states that NLB most often occurs in the 2nd stage with numbness, pain, weakness, Bell’s palsy (paralysis of the facial muscles), visual disturbances, and meningitis symptoms such as fever, stiff neck, and severe headache. Other problems, which may not appear until weeks, months, or years after a tick bite, include decreased concentration, irritability, memory and sleep disorders, and nerve damage in the arms and legs.

Again, people can hop from stage to stage with no seeming rhyme or reason and in no particular order.  Remember the story of the little girl who went out to play, got bit by a tick above her eye, and within 4-6 hours could not walk or talk.  https://madisonarealymesupportgroup.com/2017/04/14/transmission-time-for-lymemsids-infection/

That’s not a singular case, by the way.  Nor is it rare.

This literature review should cause the authors to pause and think.  Why is it that doxycycline is not superior, despite the decades of literature stating it is?

Could it be perhaps because borrelia shape-shifts and doxycycline is only effective against two forms of borrelia, leaving the third form free to proliferate?  

I tell patients, “All the doxy in the world isn’t going to cure this. It’s like taking sand and throwing it into the ocean.” Don’t get me wrong, doxy is a great front-line drug with action against many pathogens, but researcher Eva Sapi has found doxy to throw the spirochetal form into the cyst form later. I am afraid this mono-treatment might be setting people up for dementia/Alzheimer’s later on in life. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3132871/ Doxycycline reduced spirochetal structures ∼90% but increased the number of round body (cyst) forms about twofold.

For more on persistent borrelia infection: https://madisonarealymesupportgroup.com/2017/08/25/sleeper-cells-the-stringent-response-and-persistence-in-the-borreliella-burgdorferi-enzootic-cycle/
https://madisonarealymesupportgroup.com/2017/08/18/drexel-prof-lyme-persists/
https://madisonarealymesupportgroup.com/2017/12/14/live-bb-found-after-months-of-doxy/
https://madisonarealymesupportgroup.com/2015/09/19/proof-of-borrelia-persistence/