01
If symptoms persist after a standard 14-21 day course, do not assume more antibiotics will help.
02
Multiple randomized trials show no benefit and real harm from extended courses.
03
Ask the clinician to re-evaluate: confirm the original diagnosis, screen for co-infection, look for other causes (thyroid, depression, sleep apnea).
04
Consider referral to infectious disease or rheumatology if symptoms are objective (joint swelling, neurologic findings).
05
Avoid clinics that promise indefinite IV antibiotics for chronic Lyme; complications include line infections and C. difficile colitis.
06
Symptom management — sleep, exercise, mental-health support — is the evidence-based path for PTLDS.