Antibiotic therapy an effective treatment and diagnostic tool for children with persistent Lyme disease, study finds

Antibiotic therapy is not only a safe and effective method of treating persistent Lyme disease in children, it’s also a useful tool in diagnosing the condition, a newly published study from the United States has found. 

The paper, titled “Persisting Lyme Disease in the Pediatric Population” and published in the January 2026 edition of the journal Clinical Pediatrics, is the work of Dr. Sam Donta, a renowned infectious disease specialist. It’s also the latest chapter in an ongoing controversy over the nature of persistent Lyme and how health professionals should diagnose and treat it.

Some researchers and medical professionals still say persistent or chronic Lyme doesn’t exist. They question whether patients whose Lyme-related symptoms persist for months – and even years – are still infected with the tick-borne bacterium that causes the illness. Because the pathogen doesn’t show up in commonly used tests performed on these patients, some experts maintain they either have some other illness or it’s “all in their heads.”

But Donta says his research has found that when it comes to pediatric cases of persistent Lyme, “treatment with certain antibiotics over a period of time can not only be helpful as a diagnostic test, but also lead to resolution of the symptoms in most patients.” That leads him to believe that bacterial infection persists in chronic cases. 

Donta reviewed the cases of 101 children seen at the University of Connecticut Health Center and Boston Medical Center over a 15-year period. They were “recruited for the study to determine whether persistent infection is the likely cause” of their ongoing Lyme symptoms, he writes. 

The patients ranged in age from two to 19 and had a median age of 14. They were considered to have persisting Lyme disease if they had lived in or visited a region where the disease is endemic, had a tick bite or had been otherwise exposed to ticks, had a rash, and had displayed some combination of the following symptoms for more than six months:

• Fatigue,
• Musculoskeletal pain,
• Neurocognitive dysfunction. 

Diagnostic difficulties 

The study underscores an ongoing challenge associated with Lyme disease, the most common vector-borne illness in North America and Europe: how difficult it is to diagnose, not only due to slow and sometimes inaccurate testing methods and symptoms that mimic other illnesses, but also stubborn myths.

For example, many health professionals mistakenly believe the vast majority of cases feature a rash, particularly the erythema migrans or “bullseye rash.” According to the paper, just 40 per cent of the subjects had a history of a rash. Just 15 per cent had a bullseye rash.

“Most patients had been ill for a year … most had seen several specialists and had had numerous laboratory tests,” Donta writes. 

“There was no clear alternative diagnosis in any of the patients, with some being given the diagnosis of chronic fatigue or fibromyalgia.”

Doctors had performed blood tests on the patients, and had conducted brain scans on 29 of the subjects. Sixty-five per cent of those scans detected abnormalities. 

Most of the patients were given either tetracycline or a combination of the antibiotic clarithromycin, and hydroxychloroquine, or an equivalent two drug combination. Tetracycline was not given to patients less than 8 years of age. 

Antibiotics treatment reasonable and effective

Treatment with specific antibiotics over time resolved the illness in most children,” the article says. 

“A clinical diagnosis can be made based on the combination of certain persisting symptoms, and (blood) and (imaging) studies support the clinical diagnosis,” Donta continues.

“Treatment with specific antibiotics over a number of months is helpful as a diagnostic test and leads to resolution of symptoms in most patients.”

Research on Lyme disease in children is scanty, says Donta, leaving physicians with little to go on when faced with it. 

“No controlled antibiotic treatment trials have been conducted In pediatric patients with persistent Lyme disease,” he writes. 

“Until such studies can be done, the approaches to the diagnosis and treatment of pediatric patients with possible persistent Lyme disease outlined herein appear to be reasonable and effective.”