What is the recommended dose of doxycycline (doxy) for a patient with a history of Lyme disease, who had a tick attached for 5 days, developed a resolved erythema migrans rash, and vomited 30 minutes after taking a 200mg dose of doxycycline (Doxy)?

From the Guidelines

The patient should be restarted on doxycycline at 100 mg twice daily for 10-14 days, as the initial 200 mg single dose was likely not adequately absorbed due to vomiting 30 minutes after administration. The presence of erythema migrans, as indicated by the red ring rash, strongly suggests early Lyme disease, which requires proper antibiotic treatment to prevent progression to more serious manifestations 1. According to the guidelines, doxycycline is a recommended treatment for early localized or early disseminated Lyme disease associated with erythema migrans, with a dosage of 100 mg twice per day for 10-14 days 2.

Some key points to consider in the treatment of this patient include:

• The patient's history of Lyme disease and the recent tick attachment increase the risk of reinfection, making prompt treatment essential.
• The resolved red ring rash is consistent with erythema migrans, a characteristic symptom of early Lyme disease.
• Doxycycline is a preferred oral regimen for the treatment of early Lyme disease, but it should be taken with food to reduce gastrointestinal side effects and with 8 ounces of fluid to reduce the risk of esophageal irritation.
• If the patient has difficulty tolerating doxycycline, amoxicillin 500 mg three times daily for 14 days would be an appropriate alternative regimen, as it is also a recommended treatment for early Lyme disease 1, 2.
• The patient should be monitored for resolution of symptoms and potential side effects of the antibiotics during treatment.

From the FDA Drug Label

Adults: The usual dose of oral doxycycline is 200 mg on the first day of treatment (administered 100 mg every 12 hours)

• The patient was given doxy 200mg to be taken once and vomited 30 mins after.
• Since the patient vomited 30 minutes after taking the dose, it is likely that the dose was not fully absorbed.
• The recommended dosage for adults is 200 mg on the first day of treatment, which can be administered as 100 mg every 12 hours.
• Given that the patient vomited the initial dose, a new dose of 100mg could be considered, but it is essential to ensure the patient can tolerate it without vomiting again.
• It is crucial to monitor the patient for any signs of adverse reactions or interactions. 3

From the Research

Patient's History and Current Condition

• The patient has a history of Lyme disease and recently had a tick attached for 10 years, which was removed 5 days ago.
• A red ring appeared but has since resolved.
• The patient was given doxycycline 200mg to be taken once, but vomited 30 minutes after taking the dose.

Treatment Options

• According to 4, single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients.
• However, since the patient vomited 30 minutes after taking the dose, the effectiveness of the treatment is uncertain.
• 5 suggests that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime are effective for treating Lyme disease, but does not provide guidance on what to do if the initial dose of doxycycline is vomited.
• 6 compares parenteral ceftriaxone with oral doxycycline for the treatment of acute disseminated Lyme disease and finds both treatments to be highly effective.

Next Steps

• Considering the patient's history and current condition, it may be necessary to re-administer the doxycycline dose or consider an alternative treatment option, such as amoxicillin or ceftriaxone, as suggested by 5 and 6.
• However, without further guidance from the studies, the best course of action is unclear.
• It is essential to consult with a healthcare professional to determine the most appropriate treatment plan for the patient.