From the Guidelines
I strongly recommend completing a full course of doxycycline despite vomiting after the first dose, as the benefits of treating potential Lyme disease outweigh the risks of gastrointestinal side effects. For adults, take 100mg twice daily for 10-14 days, as recommended by the Infectious Diseases Society of America 1. To reduce stomach upset, take doxycycline with food (but not dairy products), plenty of water, and remain upright for 30 minutes after taking it. If vomiting persists, contact your healthcare provider as an alternative antibiotic like amoxicillin (for pregnant women) or cefuroxime axetil may be needed, as macrolides are not recommended as first-line therapy 1.
Key Considerations
- The tick attachment for 8 hours and presence of a rash, even though it resolved, are concerning for possible Lyme disease or other tick-borne illnesses, and completing the full antibiotic course is important to prevent long-term complications of these infections 1.
- The initial vomiting may have been due to taking the medication on an empty stomach or lying down too soon after taking it.
- If you develop severe symptoms like high fever, severe headache, or joint pain, seek immediate medical attention.
Alternative Options
- Amoxicillin (500 mg 3 times per day) or cefuroxime axetil (500 mg twice per day) for 14 days can be considered as alternative treatments, especially if doxycycline is not tolerated 1.
- It is essential to note that doxycycline has the advantage of being effective for treatment of HGA (but not for babesiosis), which may occur simultaneously with early Lyme disease 1.
From the FDA Drug Label
When doxycycline hyclate is prescribed to treat a bacterial infection, patients should be told that although it is common to feel better early in the course of therapy, the medication should be taken exactly as directed Skipping doses or not completing the full course of therapy may (1) decrease the effectiveness of the immediate treatment and (2) increase the likelihood that bacteria will develop resistance and will not be treatable by doxycycline hyclate or other antibacterial drugs in the future.
The patient had a rash that has resolved and vomited after 1 day of doxycycline.
- The patient should be advised to continue the full course of therapy as directed, if the vomiting was an isolated incident and the patient can tolerate the medication.
- If the patient is unable to tolerate the medication due to vomiting, an alternative treatment plan should be considered, such as anti-emetics or a different antibiotic regimen.
- The decision to continue or change the treatment plan should be made on a case-by-case basis, taking into account the patient's overall clinical condition and medical history 2.
From the Research
Treatment Options for Lyme Disease
- The patient had a tick on their body for 8 hours, developed a rash that has resolved, and experienced vomiting after one day of doxycycline treatment 3, 4, 5, 6, 7.
- Doxycycline is a common treatment for Lyme disease, but it may not be suitable for everyone, especially children, due to potential toxicity 3, 4.
- Alternative treatments, such as amoxicillin or cefuroxime axetil, may be considered for patients who cannot tolerate doxycycline or experience adverse reactions 3, 5, 6, 7.
Efficacy and Safety of Antibiotics
- Studies have shown that cefuroxime axetil is equally effective as doxycycline in treating early Lyme disease and preventing late Lyme disease 5, 7.
- Amoxicillin has also been found to be effective in treating Lyme disease, especially for patients with erythema migrans 3, 6.
- The safety profiles of these antibiotics vary, with doxycycline associated with more photosensitivity reactions and cefuroxime axetil associated with more diarrhea and Jarisch-Herxheimer reactions 5, 7.