Is steroid therapy indicated during acute Lyme (Lyme disease) infection?

From the Guidelines

Steroids are not recommended during acute Lyme disease treatment, except in rare cases with severe inflammatory manifestations, and only in conjunction with appropriate antibiotic therapy and under close medical supervision. The primary treatment for acute Lyme disease should be appropriate 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) 1. Using corticosteroids during acute Lyme infection can potentially suppress the immune response needed to fight the Borrelia burgdorferi bacteria, potentially allowing the infection to spread more extensively and making antibiotic treatment less effective 1.

Key Considerations

• Steroids may mask symptoms temporarily while allowing the underlying infection to progress
• In cases where there are severe inflammatory manifestations of Lyme disease, such as certain neurological presentations or carditis, steroids might occasionally be considered
• Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may be a safer option for symptom management while completing the full course of antibiotics
• Always consult with an infectious disease specialist before considering steroids in the context of Lyme disease

Treatment Guidelines

• The preferred antibiotic regimens for the treatment of acute neurologic manifestations of Lyme disease without parenchymal involvement of the brain or spinal cord include intravenous (IV) ceftriaxone, cefotaxime, penicillin G, or oral doxycycline 1
• The preferred antibiotic duration is 14–21 days 1
• Decisions about the choice of antibiotic should primarily be made based on individual factors such as side effect profile, ease of administration, ability to tolerate oral medication, and concerns about compliance unrelated to effectiveness 1

From the Research

Steroid Use in Acute Lyme Disease

• The use of steroids in acute Lyme disease is not a standard treatment approach, and there is limited evidence to support its efficacy 2.
• In some cases, corticosteroids may be used to hasten the resolution of facial seventh cranial nerve palsy, but this is not a common practice and is typically reserved for patients with no other signs or symptoms of Lyme disease and normal spinal fluid 2.
• The current recommendations for the treatment of Lyme disease focus on the use of antibiotics, such as amoxicillin, doxycycline, and ceftriaxone, which have been shown to be effective in treating the disease 2, 3, 4, 5.
• There is no evidence to suggest that steroids are necessary or beneficial in the treatment of acute Lyme disease, and their use may be associated with potential side effects and complications.

Antibiotic Treatment for Acute Lyme Disease

• The most commonly used antibiotics for the treatment of acute Lyme disease are amoxicillin, doxycycline, and ceftriaxone 2, 3, 4, 5.
• These antibiotics have been shown to be effective in treating the disease and preventing long-term complications 2, 3, 4, 5.
• The duration of antibiotic treatment typically ranges from 2 to 4 weeks, depending on the severity of the disease and the patient's response to treatment 2, 3, 4, 5.

Neurological Complications of Lyme Disease

• Neurological complications, such as Lyme neuroborreliosis, can occur in some patients with acute Lyme disease 6.
• The treatment of neurological complications typically involves the use of central nervous system-penetrant antibiotics, such as penicillin G, ceftriaxone, and doxycycline 6.
• The evidence for the efficacy of these antibiotics in treating neurological complications is limited, and further research is needed to determine the most effective treatment approach 6.