What is the recommended treatment for Lyme disease?

From the Guidelines

The recommended treatment for Lyme disease is antibiotics, with the specific regimen depending on the stage and severity of infection. For early localized or early disseminated Lyme disease, oral doxycycline (100 mg twice daily for 10-14 days) is the first-line treatment for adults, as recommended by the Infectious Diseases Society of America 1. Alternatives include amoxicillin (500 mg three times daily) or cefuroxime axetil (500 mg twice daily) for the same duration. Children are typically treated with amoxicillin or, if over 8 years old, doxycycline at weight-appropriate doses.

• The dosage for amoxicillin in children is 50 mg/kg per day in 3 divided doses (maximum, 500 mg per dose) 1.
• The dosage for doxycycline in children over 8 years old is 4 mg/kg per day in 2 divided doses (maximum, 100 mg per dose) 1. For more severe cases, including neurological involvement like meningitis, intravenous antibiotics such as ceftriaxone (2 g daily for 14-28 days) may be necessary. Late-stage Lyme disease often requires longer treatment courses of 2-4 weeks.
• The recommended duration of therapy for early neurologic disease is 14-28 days 1.
• The recommended duration of therapy for late neurologic disease is 14-28 days 1. Prompt treatment is crucial as antibiotics are most effective when started early, preventing the infection from spreading throughout the body. The antibiotics work by killing the Borrelia burgdorferi bacteria that cause Lyme disease. During treatment, some patients may experience a Jarisch-Herxheimer reaction (temporary worsening of symptoms) as bacteria die off, but this typically resolves within 24-48 hours.
• Macrolide antibiotics are not recommended as first-line therapy for early Lyme disease, because those macrolides that have been compared with other antimicrobials in clinical trials have been found to be less effective 1.
• First-generation cephalosporins, such as cephalexin, are ineffective for treatment of Lyme disease and should not be used 1.

From the Research

Treatment Options for Lyme Disease

The recommended treatment for Lyme disease varies depending on the stage and severity of the disease.

• For early stages of Lyme disease, oral antibiotics such as amoxicillin, doxycycline, or tetracycline are commonly used 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.
• For later stages of Lyme disease, such as carditis and neurological disease, intravenous antibiotics like cefotaxime, ceftriaxone, or benzylpenicillin may be necessary 2.
• Alternative antibiotics like cefuroxime axetil have been shown to be effective in children with early Lyme disease, especially for those who cannot tolerate amoxicillin 4.

Duration of Treatment

• The duration of treatment for Lyme disease typically ranges from 2 to 4 weeks, depending on the stage and severity of the disease 2, 5.
• Longer duration therapy has not been shown to be more effective and may lead to unnecessary antibiotic use 2.
• In some cases, such as isolated facial seventh cranial nerve palsy, oral therapy may be sufficient, but concomitant corticosteroids may be used to hasten resolution 2.

Special Considerations

• Patients with persistent symptoms, such as fibromyalgia, may require special care to determine if the symptoms are caused by a process that is no longer antibiotic-sensitive 2.
• The use of antibiotics for "chronic Lyme disease" should be approached with caution to avoid prolonged or unending courses of antibiotics for noninfectious problems 2.