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. When it comes to treating Lyme disease, the primary goal is to reduce morbidity, mortality, and improve quality of life.
- The treatment approach varies depending on the stage and severity of the disease.
- For adult patients with Lyme arthritis, doxycycline, amoxicillin, or cefuroxime axetil for 28 days is recommended 1.
- In children, amoxicillin, cefuroxime axetil, or doxycycline (if 8 years of age) is recommended 1.
- Patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy should be re-treated with another 4-week course of oral antibiotics or with a 2–4-week course of intravenous ceftriaxone 1.
- Adult patients with late neurologic disease affecting the central or peripheral nervous system should be treated with ceftriaxone (2 g once per day intravenously for 2–4 weeks) 1.
- Prevention is also crucial and includes using insect repellent containing DEET, wearing protective clothing in wooded areas, checking for ticks after outdoor activities, and removing attached ticks promptly with fine-tipped tweezers.
- Early symptoms of Lyme disease include a bull's-eye rash (erythema migrans), fever, fatigue, headache, and muscle aches, and if left untreated, it can progress to affect the joints, heart, and nervous system, causing more serious complications that are harder to treat.
From the Research
Overview of Lyme Disease
- Lyme disease is a multisystem inflammatory disease caused by infection with Borrelia burgdorferi 2
- The disease is transmitted to humans through the bite of the Ixodes tick (Ixodes scapularis and Ixodes pacificus) 3
- Approximately 20,000 cases of Lyme disease are reported annually in the United States 3
Treatment Options
- Oral antibiotics such as amoxicillin, doxycycline, and cefuroxime axetil are effective for treating early localized Lyme disease 4, 2, 3
- Intravenous antibiotics such as ceftriaxone and penicillin G are used for late or severe disease 2, 3, 5
- Azithromycin is an alternative treatment option for early localized Lyme disease 4, 6
- Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients 3
Efficacy and Safety of Antibiotics
- Amoxicillin, azithromycin, ceftriaxone, and cefotaxime were found to be effective for treating Lyme disease in a network meta-analysis 6
- Cefuroxime and penicillin were found to be safe for treating Lyme disease 6
- Doxycycline was not found to have significant efficacy and safety for treating Lyme disease, Lyme arthritis, and Lyme neuroborreliosis in adults and children 6
Special Considerations
- Patients with severe early manifestations of Lyme disease should be treated orally, unless they have carditis or neurological disease, which requires intravenous antibiotics 2
- Patients with isolated facial seventh cranial nerve palsy may be treated with oral therapy, but some physicians may prescribe concomitant corticosteroids to hasten the resolution of the palsy 2
- A small minority of patients (<10%) may not respond to treatment, which may be due to long-term persistence of borrelial cysts and misdiagnoses based solely on seropositivity 5