What is Lyme disease (Lyme borreliosis)?

From the Guidelines

Lyme disease should be treated with doxycycline 100mg twice daily for 28 days in adult patients without clinical evidence of neurologic disease, as recommended by the Infectious Diseases Society of America 1. The treatment of Lyme disease depends on the stage and severity of the infection. For adults with early localized Lyme disease, doxycycline is the preferred treatment due to its efficacy and ease of administration.

• Doxycycline (100mg twice daily) is recommended for 28 days in adult patients without neurologic disease 1.
• Amoxicillin (500mg three times daily) or cefuroxime axetil (500mg twice daily) are alternative treatments for those who cannot take doxycycline 1.
• For children, amoxicillin or doxycycline (if 8 years of age or older) are recommended, with the dosage adjusted according to weight 1. In cases of persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, re-treatment with another 4-week course of oral antibiotics or a 2-4 week course of intravenous ceftriaxone may be necessary 1.
• A second 4-week course of oral antibiotic therapy is favored for patients whose arthritis has improved but not completely resolved, while intravenous antibiotic therapy is reserved for those whose arthritis has failed to improve or worsened 1. For adult patients with late neurologic disease, ceftriaxone (2g once daily intravenously for 2-4 weeks) is the recommended treatment, with cefotaxime or penicillin G as alternative options 1.
• Re-treatment is not recommended unless relapse is shown by reliable objective measures 1.

From the Research

Overview of Lyme Disease

• Lyme disease is a heavy public health burden, with approximately 20,000 cases reported annually in the United States 2
• The disease is transmitted to humans through the bite of the Ixodes tick and can cause a range of symptoms, including erythema migrans, fever, malaise, fatigue, headache, myalgias, and arthralgias 2

Treatment Options

• Oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime are effective for treating Lyme disease 3
• Cefuroxime and penicillin are safe for treating Lyme disease 3
• Doxycycline is also commonly used to treat Lyme disease, and has been shown to be noninferior to ceftriaxone in some studies 4
• The choice of treatment may depend on the stage and severity of the disease, as well as the patient's individual needs and medical history 2, 5

Neurological Complications

• Lyme neuroborreliosis (LNB) is a serious complication of Lyme disease that can cause neurological symptoms such as neuropathy or encephalopathy 6
• Central nervous system-penetrant antibiotics such as doxycycline, penicillin G, ceftriaxone, and cefotaxime are commonly used to treat LNB 6
• A study comparing oral doxycycline to intravenous ceftriaxone found that the two treatments were equally effective in treating LNB 4

Efficacy and Safety

• The efficacy and safety of antibiotics for treating Lyme disease is still a topic of debate, and more research is needed to fully understand the benefits and risks of different treatment options 3, 6
• Some studies have reported that a small minority of patients do not respond to treatment, which may be due to long-term persistence of borrelial cysts or misdiagnoses based solely on seropositivity 5