A Review of Antibiotic-Tolerant Persisters and Their Relevance to Posttreatment Lyme Disease Symptoms

Am J Med. 2020 Apr;133(4):429-431. doi: 10.1016/j.amjmed.2019.12.007. Epub 2020 Jan 9.


Several well-controlled clinical trials have shown that prolonged antibiotic therapy has no benefit in relieving posttreatment Lyme disease symptoms. However, some insist that such symptoms are due to a persistent Borrelia burgdorferi infection requiring prolonged antibiotic therapy to resolve. This unproven view is bolstered by the results of in vitro experiments where small numbers of viable B. burgdorferi can be detected after treatment with antibiotics. The results described in the present work suggest that the presence of persisters can best be explained by classic biochemical kinetics and that there are alternative explanations for this phenomenon that appears to have no clinical significance.

Keywords: Borrelia burgdorferi; Chronic Lyme disease; Lyme disease.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use*
  • Borrelia burgdorferi / isolation & purification*
  • Drug Resistance, Bacterial*
  • Humans
  • Post-Lyme Disease Syndrome / drug therapy*
  • Post-Lyme Disease Syndrome / microbiology*


  • Anti-Bacterial Agents