From the Guidelines
The patient should be treated with doxycycline 100mg twice daily for 10-14 days, as it is the preferred antibiotic for treating Lyme disease and is effective against Borrelia burgdorferi. This recommendation is based on the guidelines from the Infectious Diseases Society of America, which state that doxycycline, amoxicillin, or cefuroxime axetil are recommended for the treatment of adult patients with early localized or early disseminated Lyme disease associated with erythema migrans 1. The current treatment with Keflex (cephalexin) should be discontinued, as it is not effective against Borrelia burgdorferi 1.
Some key points to consider when treating this patient include:
- Doxycycline is relatively contraindicated during pregnancy or lactation and in children under 8 years of age 1
- Alternative treatments, such as amoxicillin 500mg three times daily for 14-21 days, may be considered for patients who cannot take doxycycline 1
- The patient should be monitored for signs of Jarisch-Herxheimer reaction, which may indicate that the bacteria are dying 1
- The patient should seek immediate medical attention if they develop severe headache, neck stiffness, heart palpitations, or joint pain, as these may indicate progression to disseminated Lyme disease requiring more intensive treatment 1
It is essential to note that the patient's cellulitis should be closely monitored, and the treatment regimen may need to be adjusted based on the patient's response to the antibiotic therapy. Additionally, the patient should be educated on the importance of completing the full course of antibiotics, even if symptoms improve quickly.
From the Research
Treatment Options for Lyme Disease
Given the patient's Lyme panel result of 1.06, which is considered positive, and the presence of large cellulitis, the initial treatment with Keflex (cephalexin) may not be effective, as suggested by the study 2. This study found that cephalexin is not recommended for treating Lyme disease due to its poor in vitro activity.
Alternative Treatment Options
Other studies suggest alternative treatment options for Lyme disease, including:
- Oral amoxicillin (1.5 g/day) 3
- Oral azithromycin (0.5 g/day) 3
- Injectable ceftriaxone 3, 4
- Injectable cefotaxime 3, 4
- Doxycycline 5, 4
Considerations for Treatment
It is essential to note that the treatment of Lyme disease depends on the stage and severity of the disease. For early localized infection, oral antibiotics such as doxycycline or amoxicillin may be effective 5, 4. However, for more severe or disseminated infections, intravenous antibiotics such as ceftriaxone or penicillin G may be necessary 5, 4.
Neurological Complications
For patients with neurological complications, such as seventh-nerve palsy or meningitis, treatment with central nervous system-penetrant antibiotics such as doxycycline, penicillin G, ceftriaxone, or cefotaxime may be necessary 6. However, the relative efficacy of these antibiotics is not clear, and more research is needed to determine the best treatment options.