What is the treatment for patients presenting with symptoms of Lyme disease?

From the Guidelines

The treatment for patients presenting with symptoms of Lyme disease primarily involves antibiotic therapy, with doxycycline 100 mg twice daily for 10-14 days being the first-line treatment for adults, as recommended by the most recent guidelines 1. For early localized Lyme disease (characterized by erythema migrans rash), the following treatment options are available:

• Doxycycline 100 mg twice daily for 10-14 days
• Amoxicillin 500 mg three times daily for 14-21 days
• Cefuroxime axetil 500 mg twice daily for 14-21 days Children under 8 years should receive amoxicillin 50 mg/kg/day divided into three doses (maximum 1.5 g/day) for 14-21 days instead of doxycycline due to potential dental staining 1. For early disseminated or late Lyme disease with neurological involvement, cardiac manifestations, or arthritis, longer courses of antibiotics (typically 14-28 days) may be necessary, sometimes with intravenous ceftriaxone 2 g daily for severe cases 1. It is essential to note that treatment should begin promptly when Lyme disease is suspected, as early intervention prevents progression to more serious manifestations 1. The choice of antibiotic should be based on individual factors, such as side effect profile, ease of administration, and ability to tolerate oral medication 1. Patients should complete the full course of antibiotics even if symptoms resolve quickly to ensure complete eradication of the bacteria.

From the Research

Treatment for Lyme Disease

The treatment for patients presenting with symptoms of Lyme disease depends on the stage of the disease.

• For early stages of Lyme disease, oral therapy is recommended, with options including:
  • 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
• For later stages of Lyme disease, including carditis and neurological disease, treatment with intravenous antibiotics is recommended, with options including:
  • Cefotaxime (3 g every 12 hours) 2
  • Ceftriaxone (1 g every 12 hours or 2 g every day) 2, 4, 5
  • Benzylpenicillin (14 g in divided doses) 2
• Doxycycline is considered a first-line treatment for Lyme disease in adolescents and adults, and has been shown to be effective in young children as well 3
• The duration of treatment is typically 2-4 weeks, with longer duration therapy not currently indicated 2

Special Considerations

• Patients with isolated facial seventh cranial nerve palsy may be treated with oral therapy, although some physicians may prescribe concomitant corticosteroids to hasten the resolution of the palsy 2
• Patients with chronic Lyme borreliosis may be treated with doxycycline or ceftriaxone, with doxycycline being a cheaper and relatively safe option 4
• Emergency physicians should consider the diagnosis of Lyme disease in patients presenting with symptoms suggestive of the disease, and initiate appropriate treatment to minimize the potential of delayed sequelae 6