From the Guidelines
The primary treatment for Lyme disease is antibiotics, typically doxycycline for adults and children over 8 years old, with a standard regimen of 100 mg twice daily for 10 to 14 days, as recommended by the Infectious Diseases Society of America 1.
Treatment Regimens
- For adults, doxycycline (100 mg twice daily) or amoxicillin (500 mg three times daily) or cefuroxime axetil (500 mg twice daily) for 14 days is recommended 1.
- For children under 8, amoxicillin is usually prescribed at 50 mg/kg/day in three divided doses for 14 to 21 days 1.
- For children over 8, doxycycline (4 mg/kg per day in 2 divided doses, maximum 100 mg per dose) can be used 1.
Special Considerations
- Patients with neurologic involvement, such as meningitis or radiculopathy, may require parenteral therapy with ceftriaxone (2 g once per day intravenously for 14 days) or cefotaxime 1.
- Pregnant or lactating patients may be treated with amoxicillin or cefuroxime axetil, but doxycycline should be avoided 1.
Importance of Early Treatment
- Early treatment with antibiotics is highly effective because Lyme disease is caused by the bacteria Borrelia burgdorferi, which is susceptible to these medications when caught early 1.
- It's crucial to complete the entire course of antibiotics, even if symptoms improve, to ensure the infection is fully eradicated 1.
From the Research
Treatment Options for Lyme Disease
The treatment for Lyme disease (Lyme borreliosis) typically involves the use of antibiotics. The following are some of the commonly recommended treatment options:
- Amoxicillin: 50 mg/kg/day in 3 intakes for 14-21 days for adults and children above 8 years of age 2, 3, 4, 5
- Doxycycline: 100 mg bid for 14-21 days for adults, and 4 mg/kg/day in 2 intakes for children above 8 years of age 2, 3, 4, 5, 6
- Cefuroxime axetil: 500 mg twice daily for adults, and 30 mg/kg/day in 2 intakes for children 2, 3, 5
- Azithromycin: 500 mg/day for adults, and 20 mg/kg/day for children for 7-10 days 2, 3
- Ceftriaxone: 1 g every 12 hours, or 2 g every day for 2-3 weeks for later features of Lyme disease, such as carditis and neurological disease 4
Special Considerations
For children under 8 years old, amoxicillin is often the preferred treatment option, but doxycycline may be considered in certain cases 6. For patients with isolated facial seventh cranial nerve palsy, oral therapy may be sufficient, although some physicians may prescribe concomitant corticosteroids to hasten the resolution of the palsy 4.
Duration of Therapy
The duration of therapy for Lyme disease typically ranges from 10 to 21 days, although the optimal duration of therapy is unknown 2, 3, 4. Longer duration therapy has not been shown to be more efficacious, and may even lead to unnecessary side effects 4.
Treatment of Chronic Lyme Disease
The treatment of chronic Lyme disease, also known as post-treatment Lyme disease syndrome, is a major challenge, and there is no evidence that prolonged or unending courses of antibiotics are effective in treating this condition 4, 5.