Lingering Lyme Disease: A Ticking Time Bomb

Daniel Holland, PharmD
Published Online: Wednesday, June 29th, 2016
If left untreated, Lyme disease can have serious complications.

Lyme disease is the most common tick-borne disease in North America, and your patients may become more susceptible to it as they head outside for summer activities.
It’s common for patients to visit retail clinics when they suspect that they’ve been bitten. The disease initially presents 1 to 2 weeks after the tick bite and develops over the course of a few days. The rash may go unnoticed if it’s in a difficult location to inspect, such as the buttocks, axillae, or behind the knee.

Patients may visit retail clinics to discuss these symptoms without knowing that they’re associated with Lyme disease, so it’s important for retail clinicians to ask questions and proactively perform testing if Lyme disease is suspected.

According to the Mayo Clinic, untreated Lyme disease can also cause the following complications:
  • Chronic joint inflammation (Lyme arthritis), particularly of the knee
  • Neurological symptoms, such as facial palsy and neuropathy
  • Cognitive defects, such as impaired memory
  • Heart rhythm irregularities
  • Depression associated with coping from other symptoms
Patients with arthritis who lack neurologic symptoms should receive doxycycline, amoxicillin, or cefuroxime regimens for 28 days. Patients with comorbid Lyme arthritis and neurologic complications or recurrent disease should receive the cefuroxime regimen for 28 days.

Patients may experience a delayed antibiotic response in late-stage Lyme disease by weeks to months. Clinicians may treat a mild arthritis recurrence with a second course of antibiotics. Ongoing fatigue, musculoskeletal pain, or cognitive difficulties after antibiotic therapy will most likely not respond to antibiotics or represent an active infection.

Retail clinicians can help patients reduce the risk of tick bites and tick-borne diseases by pointing out CDC recommendations, which include the following:
  • Use insect repellent when outdoors.
  • Avoid wooded and brushy areas with high grass and leaf litter. 
  • Use products that contain permethrin on clothing.
  • Bath or shower as soon as possible after coming indoors to wash off or find ticks.
  • Examine outdoor gear and pets.

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