Is ceftriaxone (a third-generation cephalosporin antibiotic) effective against Lyme disease?

From the Guidelines

Ceftriaxone is effective against Lyme disease and is considered a first-line treatment for certain stages of the infection, particularly for acute neurologic manifestations without parenchymal involvement of the brain or spinal cord. According to the 2020 guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) 1, intravenous ceftriaxone is recommended for the treatment of Lyme disease-associated meningitis, cranial neuropathy, radiculoneuropathy, or other peripheral nervous system (PNS) manifestations. The preferred duration of treatment is 14-21 days.

Some key points to consider when using ceftriaxone for Lyme disease treatment include:

• The dose of ceftriaxone is typically 2 grams once daily for adults, and 50-75 mg/kg per day in a single dose for children (maximum 2 grams) 1
• Ceftriaxone works by inhibiting bacterial cell wall synthesis, which is effective against Borrelia burgdorferi, the spirochete bacterium that causes Lyme disease
• Intravenous administration allows the antibiotic to achieve high concentrations in tissues and cross the blood-brain barrier, making it particularly useful for treating neurological Lyme disease
• Patients receiving ceftriaxone should be monitored for potential side effects, including diarrhea, allergic reactions, and gallbladder sludging with prolonged use

It's worth noting that while ceftriaxone is effective against Lyme disease, it is not superior to oral agents and is more likely to cause serious adverse effects 1. Therefore, oral antibiotics like doxycycline, amoxicillin, or cefuroxime are usually preferred for early localized Lyme disease or less severe manifestations. However, for certain stages of the infection, such as neurological involvement, ceftriaxone is a recommended treatment option.

From the Research

Effectiveness of Ceftriaxone Against Lyme Disease

• Ceftriaxone, a third-generation cephalosporin antibiotic, has been studied for its effectiveness against Lyme disease in various clinical trials 2, 3, 4, 5, 6.
• A study published in 2003 found that adding a single dose of ceftriaxone to a 10-day course of doxycycline did not enhance therapeutic efficacy in patients with erythema migrans, a common manifestation of early Lyme disease 2.
• Another study published in 2008 compared oral doxycycline with intravenous ceftriaxone for the treatment of European Lyme neuroborreliosis and found that oral doxycycline was as efficient as intravenous ceftriaxone 3.
• A 1997 study compared parenteral ceftriaxone with oral doxycycline for the treatment of acute disseminated Lyme disease and found that both treatments were highly effective, with similar rates of clinical cure 4.
• A 2021 study compared oral doxycycline with intravenous ceftriaxone in the treatment of Lyme neuroborreliosis and found that oral doxycycline was equally effective as intravenous ceftriaxone 5.
• A 1991 study compared ceftriaxone and cefotaxime in the treatment of Lyme neuroborreliosis and found that both antibiotics were effective, but a prolongation of therapy may be necessary 6.

Key Findings

• Ceftriaxone is effective against Lyme disease, particularly in the treatment of Lyme neuroborreliosis 3, 4, 5, 6.
• The effectiveness of ceftriaxone is similar to that of doxycycline in the treatment of Lyme disease 2, 3, 4, 5.
• The optimal duration of ceftriaxone therapy for Lyme disease is not well established, but a 10- to 14-day course is commonly used 2, 3, 4, 5, 6.