01
Post-treatment Lyme disease syndrome (PTLDS) is defined as persistent fatigue, pain, or cognitive symptoms lasting more than 6 months after standard treatment.
02
Multiple randomized trials have not shown benefit from prolonged antibiotic courses, and risks (line infections, C. difficile) are real.
03
Symptom management focuses on graded exercise, sleep, cognitive-behavioral therapy, and pain control.
04
Re-evaluate for other causes: thyroid disease, sleep apnea, depression, fibromyalgia, co-infections.
05
Most patients gradually improve over 6-12 months.
06
Avoid clinics offering indefinite IV antibiotics; both IDSA and CDC advise against this approach.