A Longitudinal Study of a Large Clinical Cohort of Patients with Lyme Disease and Tick-Borne Co-Infections Treated with Combination Antibiotics

Round 1

Reviewer 1 Report

Dear authors

Congratulations for this research, this study brings good information about the combination of antibiotics as an alternative to improve the disease evolution and symptoms. Epidemiologically, data obtained could help to understand the distribution of the pathogens/diseases in the region this will minimize the spent time for the clinical examination.

Author Response

We thank Reviewer 1 for the comments to our article

Reviewer 2 Report

 

Xi, D et al’s study investigates whether long-term treatment for tick-borne infection could improve certain chronic symptoms. This longitudinal study provides significant information about treatment options and possible outcomes for tick-borne illnesses. Therefore, it is a valuable study and should be available to clinicians.

 

However, I ask the authors to make a few important changes to strengthen the quality of the manuscript.

 

Abstract: These sentences need editing because they are very confusing for the readers. For example, remove the first sentence and add relevant information to the second one. The third sentence should be placed before these sentences.

We noted a statistically significant improvement in the median ratings for general well-being from approximately 3 to 6, using a 10-point linear scale, by the second follow-up. There were statistically significant reductions in the incidence of pain (41.43%) and neurological (37.5%) symptoms between follow-ups. Only 2 of 101 patients (1.98%) discontinued treatment by the second follow-up.

 

Introduction:

Line 50 – please cite the recent CDC data which is over $476,000 cases/year

 

Material and Methods:

Please use a table when you describe inclusion and exclusion criteria.

Also, explain where the serological tests were performed and how did you test for persister forms.

Any specific species were tested for Rickettsia/Babesia and Bartonella?

 

Results/Discussion:

There were nine different combinations of antibiotic treatments were studied, but there are no data on whether any of the treatment was superior in terms of clinical outcome analyzed in this manuscript. That is probably a question a physician would ask from this study. Please provide information about that. If it was not treatment specific outcome it still needs to be discussed.

It needs some editing, please see my comments above.

Author Response

We thank Reviewer 2 for the suggestions to our article. Please see the attached file for our responses.

Author Response File: Author Response.docx