From the Guidelines
Late Lyme disease should be treated with a 2-4 week course of antibiotics, with doxycycline 100mg twice daily being the first-line option for adults, as recommended by the most recent guidelines 1.
Treatment Options
- For adults without neurological involvement, doxycycline, amoxicillin, or cefuroxime axetil for 28 days is recommended 1.
- For patients with neurological involvement, intravenous ceftriaxone 2g daily for 14-28 days may be necessary, as suggested by the 2021 guidelines 1.
- Alternative antibiotics include amoxicillin 500mg three times daily or cefuroxime 500mg twice daily.
Management of Persistent Symptoms
- Management often focuses on symptom relief, including pain medications, anti-inflammatories, and physical therapy for joint and muscle symptoms.
- Cognitive behavioral therapy may help with neuropsychiatric symptoms.
- The persistent symptoms may result from an autoimmune-like response triggered by the initial infection rather than ongoing bacterial presence, which explains why additional antibiotics often don't resolve symptoms 1.
Prevention of Late Lyme Complications
- Early diagnosis and prompt treatment of initial Lyme infection remains the best strategy to prevent late Lyme complications.
- It is essential to note that extended antibiotic courses beyond the standard duration have not shown significant benefit in controlled studies, and therefore, should be avoided unless necessary 1.
From the Research
Treatment Options for Late Lyme
- Doxycycline and ceftriaxone are commonly used antibiotics for the treatment of late Lyme borreliosis, with doxycycline being a cheaper and relatively safe option, although it may cause gastrointestinal symptoms and photosensitivity reactions more often than ceftriaxone 2.
- Ceftriaxone has been shown to be more effective than penicillin in the treatment of late Lyme borreliosis, with a higher success rate and fewer treatment failures 3.
- The optimal duration of treatment for patients with late Lyme disease is still unresolved, with some studies suggesting that a 14-day course of ceftriaxone may be sufficient, while others recommend a 28-day course 4.
Diagnosis and Clinical Presentation
- Late Lyme borreliosis can manifest with a range of symptoms, including intermittent swelling and pain of one or more joints, neurologic manifestations, and cardiovascular symptoms 5.
- Diagnosis is usually made clinically, although serologic tests can be used to confirm the presence of Borrelia burgdorferi antibodies 5, 6.
Treatment Efficacy
- The efficacy of antibiotics in treating late Lyme borreliosis can vary, with some studies suggesting that ceftriaxone and doxycycline are the most effective options, particularly in Lyme arthritis and neuroborreliosis 6.
- However, the unique pathophysiology of late Lyme borreliosis, which involves both bacterial infection and immunological response, can make treatment challenging, and antibiotics may not always be effective 6.