What is the recommended treatment for new Lyme disease?

From the Guidelines

The recommended treatment for new Lyme disease is a course of antibiotics, with doxycycline being the first-line medication for most adults and children over 8 years old. The typical regimen is doxycycline 100 mg twice daily for 10-14 days for early localized disease (single erythema migrans rash) 1. For patients who cannot take doxycycline, such as pregnant women or children under 8, alternatives include amoxicillin (500 mg three times daily for adults; 50 mg/kg/day divided into three doses for children) or cefuroxime axetil (500 mg twice daily for adults; 30 mg/kg/day divided into two doses for children), also for 14 days 1. Early treatment is crucial as it prevents progression to later stages of Lyme disease that can affect the heart, joints, and nervous system. Antibiotics work by killing the Borrelia burgdorferi bacteria transmitted through tick bites. Patients should complete the entire course of antibiotics even if symptoms improve before finishing treatment. 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 and is not a reason to discontinue treatment.

Key points to consider:

• Doxycycline is the preferred treatment for adults and children over 8 years old due to its effectiveness and ability to treat potential co-infections 1.
• Amoxicillin and cefuroxime axetil are suitable alternatives for patients who cannot take doxycycline 1.
• The duration of treatment is typically 10-14 days for early localized disease, but may be longer for more severe or disseminated disease 1.
• Patients should be closely monitored for signs of treatment failure or relapse, and alternative treatments may be necessary in some cases 1.

From the FDA Drug Label

Two adequate and well-controlled studies were performed in patients with early Lyme disease. In these studies all patients had to present with physician-documented erythema migrans, with or without systemic manifestations of infection Patients were randomized in a 1:1 ratio to a 20-day course of treatment with cefuroxime axetil 500 mg twice daily or doxycycline 100 mg 3 times daily.

The efficacy data summarized below are specific to this “validated” patient subset, while the safety data summarized below reflect the entire patient population for the 2 studies

Table 7: Clinical Effectiveness of Cefuroxime Axetil Tablets Compared to Doxycycline in the Treatment of Early Lyme Disease

Part I (1 Month Posttreatment)* Part II (1 Year Posttreatment)† Cefuroxime Axetil Doxycycline Cefuroxime Axetil Doxycycline (n = 125) (n = 108) (n = 105‡) (n = 83‡) Satisfactory clinical outcome§ 91% 93% 84% 87% Clinical cure/success 72% 73% 73% 73% Clinical improvement 19% 19% 10% 13%

The recommended treatment for new Lyme disease is cefuroxime axetil 500 mg twice daily for 20 days or doxycycline 100 mg 3 times daily for 20 days.

• Key points:
  • Cefuroxime axetil and doxycycline were effective in treating early Lyme disease.
  • Cefuroxime axetil and doxycycline were effective in prevention of the development of sequelae of late Lyme disease.
  • The incidence of drug-related adverse events was similar in the 2 treatment groups, but the incidence of drug-related diarrhea was statistically significantly higher in the cefuroxime axetil arm versus the doxycycline arm. 2

From the Research

Treatment Options for New Lyme Disease

The recommended treatment for new 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 cefuroxime axetil are commonly used 3, 4, 5.
• The duration of treatment typically ranges from 10 to 21 days, although the optimal duration is unknown 5.
• For children, amoxicillin is often the preferred treatment, but doxycycline may be used as an alternative in certain cases 6.
• In cases of Lyme neuroborreliosis, intravenous ceftriaxone or oral doxycycline may be used, with equal effectiveness reported in pediatric patients 7.

Special Considerations

• Patients with severe early manifestations of Lyme disease should be treated orally, unless they have carditis or neurological disease, which may require intravenous antibiotics 3.
• Isolated facial seventh cranial nerve palsy may be treated with oral therapy, although some physicians may prescribe concomitant corticosteroids 3.
• Persistent symptoms, such as fibromyalgia, may not be responsive to antibiotic treatment and require special care in management 3.

Antibiotic Regimens

• Oral beta-lactam antibacterials, such as amoxicillin and cefuroxime axetil, are effective first-line treatments for early Lyme disease 5.
• Oral tetracyclines, such as doxycycline, are also effective first-line treatments, although they may be contraindicated in children under 8 years old due to concerns about tooth staining 3, 6.
• Macrolides, such as erythromycin and azithromycin, are considered second-line agents due to their lower clinical efficacy compared to beta-lactams and tetracyclines 5.