From the Guidelines
The recommended treatment for Lyme disease is antibiotics, with the specific regimen depending on the stage and severity of infection, as outlined in the guidelines by the Infectious Diseases Society of America 1. 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. Alternative oral antibiotics include amoxicillin (500 mg three times daily) or cefuroxime axetil (500 mg twice daily) for the same duration, which are particularly important for:
- Children under 8
- Pregnant women
- Those with doxycycline allergies For late Lyme disease or cases with neurological involvement, intravenous antibiotics like ceftriaxone (2 g daily for 14-28 days) may be necessary. Treatment should begin as soon as possible after diagnosis, as early intervention leads to better outcomes. The antibiotics work by killing the Borrelia burgdorferi bacteria that cause Lyme disease. Some patients may experience a Jarisch-Herxheimer reaction (temporary worsening of symptoms) when treatment begins as bacteria die off, but this typically resolves within 24-48 hours. Complete the full course of antibiotics even if symptoms improve to ensure the infection is fully cleared. Key considerations in treatment selection include the patient's age, pregnancy status, and presence of neurological involvement, as well as potential allergies to specific antibiotics 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
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.