From the Guidelines
Doxycycline and amoxicillin are the primary antibiotics that effectively cover both Lyme disease and cellulitis, with doxycycline being the preferred option due to its efficacy against Borrelia burgdorferi and common cellulitis pathogens. For adults, the typical dosage of doxycycline is 100mg twice daily for 10-21 days, depending on the disease stage 1. Amoxicillin can also treat both conditions, particularly useful for pregnant women, children under 8, and those who cannot tolerate doxycycline. The dosage of amoxicillin for adults is 500mg three times per day, while for children, it is 50mg/kg per day in three divided doses (maximum of 500mg per day) 1.
Key Considerations
- Doxycycline is relatively contraindicated during pregnancy or lactation and in children under 8 years of age 1.
- Amoxicillin-clavulanic acid (Augmentin) may be preferred for cellulitis as it provides better coverage against skin pathogens 1.
- Cefuroxime axetil is another option that works for both conditions, with a dosage of 500mg twice per day for 14-21 days 1.
Treatment Approach
When treating both Lyme disease and cellulitis simultaneously, the longer treatment duration for Lyme disease should be followed, and patients should complete the full course even if symptoms improve quickly. It is essential to note that macrolide antibiotics are not recommended as first-line therapy for early Lyme disease and should be reserved for patients who are intolerant of, or should not take, amoxicillin, doxycycline, and cefuroxime axetil 1.
Important Notes
- First-generation cephalosporins, such as cephalexin, are ineffective for treatment of Lyme disease and should not be used 1.
- Doxycycline may cause photosensitivity, and individuals treated with doxycycline are advised to avoid exposure to the sun while receiving therapy 1.
From the FDA Drug Label
Amoxicillin has been shown to be active against most isolates of the following microorganisms, both in vitro and in clinical infections Gram-Positive Bacteria Enterococcus faecalis Staphylococcus spp. Streptococcus pneumoniae Streptococcus spp (alpha and beta-hemolytic) Gram-Negative Bacteria Escherichia coli Haemophilus influenzae Helicobacter pylori Proteus mirabilis
Antibiotics that cover both Lyme disease and cellulitis include amoxicillin.
- Lyme disease is caused by the bacterium Borrelia burgdorferi, which is a Gram-negative bacterium, but amoxicillin is effective against it.
- Cellulitis is often caused by Streptococcus and Staphylococcus species, which are both covered by amoxicillin. 2 2
From the Research
Antibiotics for Lyme Disease and Cellulitis
- The antibiotics that cover Lyme disease include amoxicillin, doxycycline, and ceftriaxone 3, 4.
- For cellulitis, cephalexin is often used, but it is not recommended for Lyme disease due to poor in vitro activity 5.
- Doxycycline and erythromycin have been shown to be effective against Borrelia burgdorferi, even when the organism is grown in the presence of eucaryotic cells 6.
- A systematic review of the treatment of early Lyme disease found that oral beta-lactam antibacterials (such as amoxicillin and cefuroxime axetil) and oral tetracyclines (such as doxycycline) are effective first-line treatment modalities 7.
Treatment Options
- Amoxicillin and doxycycline are first-line treatment options for early stage Lyme borreliosis 4.
- Ceftriaxone and doxycycline are the most efficient antibiotics for Lyme arthritis and neuroborreliosis 4.
- Azithromycin and cefuroxime axetil are alternative second-line options for the treatment of early Lyme disease 4, 7.
Important Considerations
- Cephalexin should not be used to treat early Lyme disease and should be prescribed with caution during the summer months for patients believed to have cellulitis in locations where Lyme disease is endemic 5.
- The optimal duration of therapy for Lyme disease is unknown, but courses of therapy ranging from 10 to 21 days are supported by the available evidence 7.