From the Guidelines
Lyme disease is treated with antibiotics, with the specific regimen depending on the stage and severity of the infection, and doxycycline 100mg twice daily for 10-14 days is the first-line treatment for adults, as recommended by the Infectious Diseases Society of America 1. The treatment of Lyme disease is guided by the stage and severity of the infection, with early localized disease typically treated with oral antibiotics, while more advanced disease may require longer courses of antibiotics, sometimes given intravenously.
- For early localized Lyme disease, doxycycline 100mg twice daily for 10-14 days is the first-line treatment for adults, as it has been shown to be highly effective in treating erythema migrans and associated symptoms 1.
- Alternatives to doxycycline include amoxicillin 500mg three times daily or cefuroxime 500mg twice daily for the same duration, with the choice of antibiotic depending on the patient's age, pregnancy status, and other factors 1.
- Children are typically treated with amoxicillin or, if over 8 years old, doxycycline at weight-appropriate doses, with the dosage and duration of treatment depending on the stage and severity of the infection 1.
- For more advanced Lyme disease with neurological involvement, cardiac issues, or persistent arthritis, longer courses of antibiotics (2-4 weeks) may be necessary, sometimes given intravenously, as recommended by the Infectious Diseases Society of America 1. Some patients may experience a Jarisch-Herxheimer reaction, a temporary worsening of symptoms, as the bacteria die off, but it is essential to complete the full course of antibiotics even if symptoms improve 1. After treatment, some symptoms may persist for weeks or months, but this does not typically indicate ongoing infection or need for additional antibiotics, and prevention through tick avoidance, prompt tick removal, and appropriate clothing in tick-endemic areas remains crucial 1.
From the Research
Treatment Options for Lyme Disease
- Oral antibiotics such as amoxicillin (500 mg 3 or 4 times daily) 2, doxycycline (100 mg twice daily) 2, and cefuroxime axetil 3, 4 are effective for treating early Lyme disease.
- Intravenous antibiotics such as ceftriaxone (1 g every 12 hours or 2 g every day) 2 and cefotaxime (3 g every 12 hours) 2 are used to treat later stages of Lyme disease, including carditis and neurological disease.
- The duration of therapy ranges from 10 to 21 days for early Lyme disease 3 and 2 to 3 weeks for later stages of the disease 2.
- Alternative treatments include phenoxymethylpenicillin (penicillin V), tetracycline, erythromycin, and azithromycin 3.
Special Considerations
- Children with early Lyme disease can be treated with amoxicillin (50 mg/kg/d) or cefuroxime axetil (20 mg/kg/d or 30 mg/kg/d) 4.
- Patients with isolated facial seventh cranial nerve palsy may be treated with oral antibiotics, but some physicians may prescribe concomitant corticosteroids to hasten the resolution of the palsy 2.
- Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients 5.
Efficacy and Safety of Antibiotics
- A network meta-analysis found that oral amoxicillin (1.5 g/day), oral azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease 6.
- Cefuroxime and penicillin were found to be safe for treating Lyme disease 6.
- Amoxicillin was effective for treating erythema migrans, a common manifestation of Lyme disease 6.