From the Guidelines
The recommended treatment for Lyme disease depends on the stage and severity of infection, with doxycycline 100mg twice daily for 10-14 days being the first-line treatment for adults with early localized Lyme disease, as supported by the Infectious Diseases Society of America guidelines 1.
Key Considerations
- For early localized Lyme disease (single erythema migrans rash), alternatives to doxycycline include amoxicillin 500mg three times daily or cefuroxime axetil 500mg twice daily for 14-21 days.
- Children under 8 years should receive amoxicillin 50mg/kg/day divided into three doses (maximum 500mg per dose) for 14-21 days.
- For early disseminated or late Lyme disease with multiple rashes, neurological, cardiac, or joint involvement, treatment duration extends to 14-28 days.
- Severe cases may require intravenous antibiotics like ceftriaxone 2g daily for 14-28 days.
Treatment Guidelines
- The Infectious Diseases Society of America recommends the following treatment regimens:
- Doxycycline (100 mg twice per day), amoxicillin (500 mg 3 times per day), or cefuroxime axetil (500 mg twice per day) for 14 days (range, 10–21 days for doxycycline and 14–21 days for amoxicillin or cefuroxime axetil) for adult patients with early localized or early disseminated Lyme disease associated with erythema migrans 1.
- Ceftriaxone (2 g once per day intravenously for 14 days; range, 10–28 days) for adult patients with early Lyme disease and the acute neurologic manifestations of meningitis or radiculopathy 1.
Special Considerations
- Pregnant or lactating patients may be treated in a fashion identical to nonpregnant patients with the same disease manifestation, except that doxycycline should be avoided 1.
- Coinfection with B. microti or A. phagocytophilum or both may occur in patients with early Lyme disease, and should be considered in patients who present with more severe initial symptoms than are commonly observed with Lyme disease alone 1.
From the Research
Treatment Guidelines for Lyme Disease
The treatment guidelines for Lyme disease vary depending on the stage and severity of the disease.
- For early-stage Lyme disease, oral antibiotics such as doxycycline, amoxicillin, or azithromycin are recommended 2.
- Doxycycline is considered the first-line treatment for Lyme disease in adolescents and adults, but its use in children under 8 years old has been limited due to concerns about tooth staining 3.
- However, recent studies suggest that doxycycline is safe and effective for young children with Lyme disease, and its use is increasing in this age group 4.
- For later stages of Lyme disease, such as neurological or cardiac involvement, intravenous antibiotics like ceftriaxone or penicillin may be necessary 5.
- The duration of treatment typically ranges from 2 to 4 weeks, depending on the stage and severity of the disease 5, 6.
Antibiotic Options
Different antibiotics have been studied for the treatment of Lyme disease, including:
- Doxycycline: effective for early-stage Lyme disease and increasingly used in young children 3, 4.
- Amoxicillin: commonly used for early-stage Lyme disease, especially in children under 8 years old 5, 2.
- Ceftriaxone: used for later stages of Lyme disease, such as neurological or cardiac involvement 5, 6.
- Azithromycin: an alternative option for early-stage Lyme disease, but may have a higher risk of treatment failure 2.