In his article, Sigal1 provides a thoughtful summary and discussion of the problems associated with the misdiagnosis and mismanagement of Lyme disease (LD), and we agree with most of his conclusions. However, we were puzzled by the statement in the table that "there is a strong suggestion that 10 to 14 days of therapy may be insufficient" in early localized disease.1 We are unaware of evidence to support this claim. Indeed, this recommendation seems particularly surprising since Sigal indicates that "no proof exists that... more than 10 to 14 days of treatment is necessary" for early disseminated and late (chronic) LD.
To our knowledge, only 3 published studies2-4 have examined the duration of treatment in humans with early (North American) LD. In the first study,2 coauthored by Sigal, no outcome differences were shown for 49 patients with erythema migrans who were treated with tetracycline for either
Nadelman RB, Nowakowski J, Wormser GP. A Lyme Disease Controversy: Duration of Treatment. Arch Intern Med. 1997;157(6):697-700. doi:10.1001/archinte.1997.00440270151016