From the Guidelines
The recommended antibiotics for treating Lyme disease include doxycycline, amoxicillin, and cefuroxime, with doxycycline 100 mg twice daily for 10-21 days being the first choice for adults, as supported by the Infectious Diseases Society of America guidelines 1. For early localized or early disseminated Lyme disease, alternatives include amoxicillin 500 mg three times daily or cefuroxime axetil 500 mg twice daily for the same duration. Children are usually treated with amoxicillin 50 mg/kg/day divided into three doses (maximum 500 mg per dose) or doxycycline if over 8 years old. Some key points to consider in the treatment of Lyme disease include:
- The choice of antibiotic may depend on the stage and severity of the disease, as well as the patient's age and other health factors.
- Doxycycline is generally the preferred treatment for adults, but amoxicillin or cefuroxime may be used as alternatives.
- For late Lyme disease or more severe manifestations like Lyme arthritis or neurological involvement, treatment may be extended to 28 days.
- Intravenous antibiotics such as ceftriaxone 2 g daily for 14-28 days may be necessary for severe neurological manifestations.
- These antibiotics are effective because they target the Borrelia burgdorferi spirochete that causes Lyme disease, with good penetration into tissues where the bacteria may reside.
- Treatment should begin as soon as possible after diagnosis, as delayed treatment can lead to more persistent symptoms, as noted in the guidelines 1. It's also important to note that while doxycycline is the preferred treatment for Lyme disease, it may not be suitable for all patients, such as those who are pregnant or breastfeeding, or those with certain medical conditions, and alternative treatments may be necessary in these cases, as discussed in the guidelines 1.
From the Research
Recommended Antibiotics for Lyme Disease
The following antibiotics are recommended for treating Lyme disease:
- Amoxicillin (500 mg 3 or 4 times daily) with or without probenecid 500 mg 3 times daily 2
- Doxycycline (100 mg twice daily) 2, 3, 4, 5
- Tetracycline (500 mg 4 times daily) 2
- Cefotaxime (3 g every 12 hours) 2
- Ceftriaxone (1 g every 12 hours or 2 g every day) 2, 5
- Benzylpenicillin (14 g in divided doses) 2
Treatment Duration
The recommended treatment duration for Lyme disease is:
- 3 to 4 weeks of oral therapy for early disease 2
- 2 to 3 weeks of intravenous antibiotics for later features of Lyme disease, such as carditis and neurological disease 2
- 10 to 20 days of oral doxycycline for early Lyme disease, with no significant difference in efficacy between the two durations 5
Special Considerations
- For young children, doxycycline is considered a safe and effective alternative to amoxicillin for treating Lyme disease 3
- For children, a twice-daily dosing of 25 mg/kg/dose of amoxicillin may provide comparable bactericidal activity to a thrice-daily regimen for certain minimum inhibitory concentrations (MICs) 6