From the Guidelines
Pregnant women with Lyme disease should be treated promptly with amoxicillin 500 mg three times daily for 14-21 days, as this antibiotic is safe during pregnancy and effective in preventing complications for both mother and baby. Doxycycline, which is typically used for non-pregnant adults, should be avoided during pregnancy due to potential effects on fetal bone and tooth development 1. For penicillin-allergic patients, cefuroxime axetil 500 mg twice daily for 14-21 days is an alternative. Early treatment is crucial as untreated Lyme disease during pregnancy may lead to placental infection, potentially causing adverse outcomes such as miscarriage, stillbirth, or congenital abnormalities, though these are rare. While there is no evidence of Lyme disease transmission through breast milk, infected mothers should still receive appropriate antibiotic treatment. Some key points to consider in the treatment of Lyme disease in pregnancy include:
- The use of amoxicillin as the first-line treatment due to its safety and efficacy in pregnancy 1
- The avoidance of doxycycline in pregnancy due to its potential effects on fetal development 1
- The importance of early treatment to prevent complications and adverse outcomes 1
- The need for pregnant women to take preventive measures against tick bites, including wearing protective clothing, using EPA-approved repellents, and performing regular tick checks after outdoor activities in endemic areas 1
- The proper removal of attached ticks and monitoring for symptoms of Lyme disease, such as the characteristic bull's-eye rash, fever, fatigue, and joint pain 1
From the Research
Lyme Disease in Pregnancy
- Lyme disease is a bacterial infection that can be transmitted to humans through the bite of an infected tick 2.
- The management of Lyme borreliosis in pregnant women involves early detection of attached ticks and their prompt removal, as well as a "wait and watch" strategy, with early treatment with antibiotics if signs or symptoms of the disease arise 2.
Treatment Options
- Antibiotic treatment of pregnant patients is restricted to those having a reliable clinical diagnosis of Lyme borreliosis, and may include intravenous antibiotic treatment with penicillin or ceftriaxone 2 g daily for 14 days 2.
- Oral amoxicillin and doxycycline are first-line treatment options for erythema migrans, the hallmark of early stage Lyme borreliosis, although doxycycline is not recommended for pregnant women due to potential risks to the fetus 3.
- Ceftriaxone is a parenteral agent that is effective for severe acute and chronic infections, due to its good penetration into the central nervous system (CNS) and convenient single daily dosage regimen 4.
Efficacy and Safety of Antibiotics
- A network meta-analysis of 31 randomized controlled trials 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 5.
- The same study found that amoxicillin was effective for treating erythema migrans, but did not observe significant efficacy and safety of doxycycline for treating Lyme disease 5.
- Another study found that ceftriaxone and doxycycline were the most efficient antibiotics for treating Lyme arthritis and neuroborreliosis, although they were less efficient in late Lyme borreliosis 3.