What is Lyme disease?

From the Guidelines

Lyme disease should be treated with a 10-14 day course of oral antibiotics, such as doxycycline (100mg twice daily), amoxicillin (500mg three times daily), or cefuroxime (500mg twice daily), as recommended by the Infectious Diseases Society of America 1.

Key Considerations

• The choice of antibiotic depends on the stage of infection and patient factors, such as pregnancy or age.
• Doxycycline is effective against Lyme disease and human granulocytic anaplasmosis, but is relatively contraindicated in pregnant women and children under 8 years old.
• Amoxicillin and cefuroxime are alternative options for patients who cannot take doxycycline.

Prevention and Prophylaxis

• Prevention of Lyme disease includes using tick repellents, wearing protective clothing, and removing attached ticks promptly.
• Prophylaxis with a single dose of doxycycline may be offered to adult patients and children 8 years of age or older who have been bitten by an infected tick, under certain circumstances, such as the tick being an adult or nymphal I. scapularis tick that has been attached for at least 36 hours 1.

Monitoring and Follow-up

• Patients who have removed attached ticks should be monitored closely for signs and symptoms of tickborne diseases for up to 30 days.
• Early symptoms of Lyme disease include a bull's-eye rash, fever, fatigue, headache, and muscle aches, and prompt treatment is essential to prevent complications. Some key points to consider when treating Lyme disease include:
• The importance of prompt treatment to prevent complications.
• The need for monitoring and follow-up to ensure that the patient is responding to treatment and to detect any potential complications early.
• The use of prophylaxis in certain circumstances to prevent the development of Lyme disease after a tick bite. It is also important to note that:
• Lyme disease can progress to affect the joints, heart, and nervous system if left untreated.
• The bacterium Borrelia burgdorferi causes Lyme disease, and antibiotics are most effective when administered early in the course of infection 1.

From the Research

Overview of Lyme Disease

• Lyme disease is the most common tick-borne disease in the United States, with approximately 20,000 cases reported annually 2.
• The disease is transmitted to humans through the bite of the Ixodes tick (Ixodes scapularis and Ixodes pacificus) and can be divided into three stages: early localized infection, early disseminated infection, and late disseminated infection 2, 3.

Risk Factors and Clinical Presentation

• Residents of the coastal Northeast, northwest California, and the Great Lakes region are at highest risk, as well as children and those spending extended time outdoors in wooded areas 2.
• Clinical features of Lyme disease include erythema migrans, fever, malaise, fatigue, headache, myalgias, and arthralgias in the early stages, and neurologic, musculoskeletal, or cardiovascular symptoms in the later stages 2, 3.
• Diagnosis is usually made clinically, with laboratory testing used as an adjunct 4, 5.

Treatment and Prevention

• Treatment of Lyme disease typically involves antibiotics such as doxycycline or amoxicillin, with ceftriaxone or penicillin G used in more severe cases 2, 6.
• Prophylaxis with doxycycline may be indicated in certain circumstances, such as in patients with a high risk of exposure 2, 3.
• Preventive measures, such as avoiding tick bites and using insect repellents, should be emphasized to patients to help reduce risk 2, 3.
• The efficacy of oral doxycycline, amoxicillin, and cefuroxime axetil for treating Lyme disease has been established in multiple trials, with a 10-day course of oral doxycycline often used for treatment of erythema migrans and a 14-day course for treatment of early neurologic Lyme disease 4.