From the study you linked, first sentence:
"Five clinical trials show that prolonged antibiotic therapy has no clear and lasting benefit in relieving posttreatment Lyme disease symptoms, a condition often called “chronic Lyme disease”;1, 2, 3, 4 no evidence of active infection was found in any of these studies by culture or molecular methods."
Almost all those citations are outdated studies from almost 20 years ago and one recent from 2016 where patients _did_ improve with antibiotics according to the data but the abstract concludes they didn't. ¯\_(ツ)_/¯
If they have to ignore recent studies and go back 20 years to "prove" antibiotics don't work then what does that tell us about bias in medicine?
2018:
>Conclusions: Using multiple corroborative detection methods, we showed that patients with persistent Lyme disease symptoms may have ongoing spirochetal infection despite antibiotic treatment, similar to findings in non-human primates. The optimal treatment for persistent Borrelia infection remains to be determined.
https://www.researchgate.net/publication/324539470_Persisten...
2019:
>We collected data from an online survey of 200 of our patients, which evaluated the efficacy of dapsone (diaminodiphenyl sulfone, ie, DDS) combined with other antibiotics and agents that disrupt biofilms for the treatment of chronic Lyme disease/post-treatment Lyme disease syndrome (PTLDS). ... Conclusion DDS CT decreased eight major Lyme symptoms severity and improved treatment outcomes among patients with chronic Lyme disease/PTLDS and associated coinfections.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388746/
2020:
> This study, which drew on a sample of over 3500 patients ... Approximately half (53%) of the patients in the study reported some improvement, and more than a third (35%) were “high responders” to antibiotic treatment, underscoring the value of large samples, subgroup analysis, and real-world evidence as standard components of Lyme disease treatment studies. This spectrum of improvement is consistent with reports for most pharmaceuticals due to patient treatment response variation
https://www.mdpi.com/2227-9032/8/4/383
They only test for Borrelia Burgdorferi. We know there are several more out there that cause Lyme symptoms.
Borrelia
japonica – Discovered 1994
andersonii – Discovered 1995
lusitaniae – Discovered 1997
bissettii – Discovered 1998
spielmanii – Discovered 2006
californiensis – Discovered 2007
mayonii – Discovered 2016
I'm betting we can add the Australian variant to that list in the future.