From the Guidelines
Lyme disease should be treated with antibiotics, with doxycycline, amoxicillin, or cefuroxime axetil being recommended for adult patients without clinical evidence of neurologic disease, for 28 days, as stated in the clinical practice guidelines by the Infectious Diseases Society of America 1. Lyme disease is a bacterial infection transmitted through the bite of infected black-legged ticks (deer ticks). It's caused by the bacterium Borrelia burgdorferi and typically begins with a characteristic bull's-eye rash called erythema migrans at the site of the tick bite in about 70-80% of cases.
Key Considerations
- Early symptoms resemble the flu, including fever, headache, fatigue, and muscle and joint aches.
- If left untreated, the infection can spread to joints, the heart, and the nervous system, causing more serious complications.
- Treatment typically involves antibiotics, with the choice of antibiotic depending on the stage and severity of the disease.
Treatment Options
- For adult patients without clinical evidence of neurologic disease, doxycycline (B-I), amoxicillin (B-I), or cefuroxime axetil (B-III) for 28 days is recommended 1.
- For children, amoxicillin (B-I), cefuroxime axetil (B-III), or doxycycline (if 8 years of age) (B-I) is recommended 1.
- For patients with persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, re-treatment with another 4-week course of oral antibiotics or with a 2–4-week course of intravenous ceftriaxone (B-III) is recommended 1.
Prevention
- Prevention is crucial and includes using tick repellents containing DEET, wearing protective clothing in wooded areas, checking for ticks after outdoor activities, and removing attached ticks promptly with fine-tipped tweezers.
- The bacterium needs approximately 36-48 hours of attachment to transmit the disease, so quick removal significantly reduces infection risk.
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 is typically associated with specific clinical features, including erythema migrans, fever, malaise, fatigue, headache, myalgias, and arthralgias 2.
Risk Factors and Prevention
- Residents of the coastal Northeast, northwest California, and the Great Lakes region are at highest risk of contracting Lyme disease 2.
- Children and those spending extended time outdoors in wooded areas are also at increased risk 2.
- Preventive measures, such as avoiding tick-infested areas and using insect repellents, can help reduce the risk of contracting Lyme disease 2.
Diagnosis and Treatment
- Diagnosis is usually made clinically, and treatment is accomplished with doxycycline or amoxicillin; cefuroxime axetil or erythromycin can be used as an alternative 2.
- Late or severe disease requires intravenous ceftriaxone or penicillin G 2.
- A network meta-analysis found that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease, while cefuroxime and penicillin were safe for treating the disease 3.
- Another study found that a 10-day course of oral doxycycline was effective for treating erythema migrans and early neurologic Lyme disease in ambulatory patients 4.
Neurological Complications
- Various central nervous system-penetrant antibiotics, including doxycycline, penicillin G, ceftriaxone, and cefotaxime, have been found to be efficacious in the treatment of European Lyme neuroborreliosis (LNB) 5.
- However, there is a lack of evidence on the efficacy of antibiotics for treatment of LNB in the United States 5.
- A study found that ceftriaxone and doxycycline were the most efficient antibiotics for treating Lyme arthritis and neuroborreliosis, but were less efficient in late Lyme borreliosis 6.