What should be done in case of persistent symptoms after adequate antibiotic treatment for Lyme disease?

The most common cause of treatment failure is incorrect diagnosis. Most patients cured of Lyme disease remain seropositive for long periods, and no laboratory test allows one to differentiate between cured and active infection. The first step is to check that the patient fulfils the diagnostic criteria for Lyme disease and that the antibiotic regimen has been administered according to the current recommendations. In the case of persistent arthritis after a first course of antibiotics, it is generally recommended to give a second course of treatment with a different drug. Ceftriaxone should be administered intravenously for arthritis that did not respond to previous oral therapy with doxycycline or amoxicillin. Despite resolution of the objective manifestations of Lyme disease after antibiotic treatment, a small proportion of patients still complain of subjective musculoskeletal pain, fatigue, difficulties with concentration or short-term memory, or all these symptoms. Given the risk of serious adverse events and the lack of efficacy, a consensus has emerged that repeated courses of antibiotic therapy are not indicated for persistent subjective symptoms following Lyme disease. The patient should be thoroughly examined for medical conditions that could explain the symptoms. If a diagnosis is made for which no specific treatment can be proposed, emotional support and management of pain, fatigue and other symptoms is required.