Is Malarone (atovaquone-proguanil) effective for long-term treatment of Lyme disease?

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Last updated: May 5, 2025View editorial policy

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From the Guidelines

Malarone (atovaquone/proguanil) is not recommended for long-term Lyme disease treatment. The standard treatment for Lyme disease involves antibiotics such as doxycycline (100mg twice daily for 10-21 days), amoxicillin (500mg three times daily for 14-21 days), or cefuroxime (500mg twice daily for 14-21 days), depending on the stage and manifestations of the disease 1. Malarone is an antimalarial medication that works by inhibiting mitochondrial electron transport in parasites, but it does not have established efficacy against Borrelia burgdorferi, the bacterium that causes Lyme disease.

For persistent symptoms following standard antibiotic treatment (sometimes called "chronic Lyme"), there is no evidence that prolonged antibiotic therapy, including Malarone, provides benefit 1. Instead, symptom-based treatment approaches are recommended. If you're experiencing ongoing symptoms after Lyme treatment, consult with an infectious disease specialist who can evaluate your condition and recommend appropriate management strategies based on current medical evidence.

Some key points to consider:

  • The IDSA, AAN, and ACR recommend against additional antibiotic therapy for patients with persistent or recurring nonspecific symptoms following recommended treatment for Lyme disease, but who lack objective evidence of reinfection or treatment failure 1.
  • For patients with Lyme arthritis with partial response after a first course of oral antibiotic, a second course of oral antibiotics for up to 1 month may be a reasonable alternative 1.
  • In patients with Lyme arthritis with no or minimal response to an initial course of oral antibiotic, a 2–4-week course of IV ceftriaxone is suggested over a second course of oral antibiotics 1.

It's essential to follow the guidelines and consult with a specialist to determine the best course of treatment for your specific condition.

From the Research

Malarone for Long Term Lyme

  • There is no mention of Malarone in the provided studies 2, 3.
  • The studies focus on the efficacy and safety of antibiotics for treating Lyme disease, such as amoxicillin, azithromycin, ceftriaxone, and cefotaxime 2.
  • The guidelines for the prevention, diagnosis, and treatment of Lyme disease do not include recommendations for Malarone 3.
  • Malarone is typically used for the prevention and treatment of malaria, not Lyme disease.
  • There is no evidence to suggest that Malarone is effective for long-term treatment of Lyme disease 2, 3.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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