From the Guidelines
Lyme disease management typically involves oral antibiotic therapy for 28 days.
Key Considerations
- For patients with Lyme arthritis, oral antibiotic therapy for 28 days is recommended 1.
- The preferred oral antibiotics are doxycycline, amoxicillin, or cefuroxime axetil 1.
- For patients with persistent or recurring nonspecific symptoms after standard treatment, additional antibiotic therapy is not recommended unless there is objective evidence of reinfection or treatment failure 1.
Special Cases
- In patients with Lyme arthritis who have a partial response to initial oral antibiotic treatment, a second course of oral antibiotics or a 2-4 week course of IV ceftriaxone may be considered 1.
- For patients with late neurologic disease, IV ceftriaxone is recommended 1.
- In cases where patients have failed one course of oral antibiotics and one course of IV antibiotics, referral to a rheumatologist for consideration of disease-modifying antirheumatic drugs, biologic agents, intraarticular steroids, or arthroscopic synovectomy may be suggested 1.
From the Research
Management of Lyme Disease
The management of Lyme disease involves appropriate antibiotic therapy, which generally leads to a favorable outcome 2, 3, 4, 5, 6. The treatment of Lyme disease is determined mainly by the clinical manifestations of the disease.
Treatment Options
- Oral therapy with amoxicillin, doxycycline, or tetracycline is recommended for early stages of Lyme disease 3, 4, 5.
- Intravenous antibiotics such as cefotaxime, ceftriaxone, and benzylpenicillin are used for later stages of Lyme disease, including carditis and neurological disease 3, 5.
- Doxycycline is often the preferred agent for oral treatment due to its activity against other tick-borne illnesses 4.
Duration of Treatment
- The duration of treatment normally ranges between 10 days and three weeks for early stages of Lyme disease 3, 5.
- Longer duration therapy has not been shown to be more efficacious and may be harmful 2, 3, 4.
Post-Treatment Lyme Disease Syndrome (PTLDS)
- PTLDS is a complex of nonspecific, subjective symptoms that are neither caused by ongoing infection nor by any other identifiable disease 2.
- There is no evidence that prolonged antibiotic treatment is of benefit for PTLDS 2, 3, 4, 6.
- The management of PTLDS requires careful evaluation of differential diagnosis and counseling about optimal management in light of missing specific therapeutic options 2.