From the Guidelines
Lyme disease should be treated with oral antibiotics, such as doxycycline or amoxicillin, for 28 days in adult patients without clinical evidence of neurologic disease, as recommended by the Infectious Diseases Society of America 1. When treating Lyme disease, it is essential to consider the stage and severity of the disease. For adult patients with Lyme arthritis, oral antibiotics such as doxycycline, amoxicillin, or cefuroxime axetil are recommended for 28 days 1.
- Doxycycline is a preferred option due to its efficacy and safety profile.
- Amoxicillin is an alternative for patients who cannot tolerate doxycycline.
- Cefuroxime axetil is another option, although it has a lower level of evidence supporting its use 1. For children, amoxicillin, cefuroxime axetil, or doxycycline (if 8 years of age or older) are recommended 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.
- Intravenous antibiotic therapy is reserved for patients whose arthritis has failed to improve or worsened 1. It is crucial to note that 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.
- Cefotaxime or penicillin G administered intravenously is an alternative 1. Prevention and early detection are key in managing Lyme disease, and patients should be educated on the importance of prompt tick removal and the use of tick repellents containing DEET 1.
From the Research
Lyme Disease Overview
- 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
- Residents of the coastal Northeast, northwest California, and the Great Lakes region are at highest risk 3
Symptoms and Stages
- The disease has three stages: early localized infection, early disseminated infection, and late disseminated infection 2, 3
- Early localized infection is characterized by erythema migrans, fever, malaise, fatigue, headache, myalgias, and arthralgias 3
- Early disseminated infection occurs days to weeks later, with neurologic, musculoskeletal, or cardiovascular symptoms and multiple erythema migrans lesions 3
- Late disseminated infection is characterized by intermittent swelling and pain of one or more joints (especially knees) 3
Treatment
- Therapy for early localized infection consists of 3 to 4 weeks of oral therapy with amoxicillin, doxycycline, or tetracycline 2
- Later features of Lyme disease, such as carditis and neurological disease, are treated with 2 to 3 weeks of intravenous antibiotics, including cefotaxime, ceftriaxone, and benzylpenicillin 2
- Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of Lyme neuroborreliosis 4
- A network meta-analysis found that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease 5
Antibiotic Efficacy and Safety
- Amoxicillin was effective for treating erythema migrans 5
- Cefuroxime and penicillin were safe for treating Lyme disease 5
- Doxycycline, penicillin G, ceftriaxone, and cefotaxime are efficacious in the treatment of European Lyme neuroborreliosis 6
- There is a lack of evidence on the efficacy of antibiotics for treatment of Lyme neuroborreliosis in the United States 6