What is the recommended dose of doxycycline (Doxycycline) for treating Lyme disease?

Doxycycline Dosing for Lyme Disease

The recommended dose of doxycycline for treating Lyme disease is 100 mg twice daily orally for 10-14 days. 1

Treatment Regimen Details

• First-line therapy: Doxycycline 100 mg twice daily for 10-14 days

  • Effective for both Lyme disease and potential co-infections like Human Granulocytic Anaplasmosis (HGA)
  • Recommended by the Infectious Diseases Society of America (IDSA) as the drug of choice 1
  • Studies show high success rates (>90%) with standard treatment courses 1

• Duration considerations:

  • 10 days of treatment is as effective as longer courses
  • Research demonstrates that extending treatment from 10 to 20 days does not enhance therapeutic efficacy 2
  • Long-term outcomes are similar for patients treated with 10 days versus longer courses 1

Alternative Treatment Options

For patients who cannot take doxycycline:

• Amoxicillin: 500 mg three times daily for 14 days 1, 3
• Cefuroxime axetil: 30 mg/kg/day in 2 divided doses (maximum 500 mg per dose) for 14-21 days (pediatric patients) 1
• Ceftriaxone: 2 g IV daily for 14 days (range 10-28 days) - for more severe cases 1

Special Populations and Contraindications

• Contraindications for doxycycline:

  • Pregnancy
  • Children under 8 years of age
  • Specific allergies or intolerances 1

• For pregnant/lactating women:

  • Amoxicillin is preferred over doxycycline 1

Monitoring and Follow-up

• Fever typically subsides within 24-48 hours after starting doxycycline treatment
• If fever persists >48 hours, reconsider diagnosis 1
• Be aware of potential Jarisch-Herxheimer reactions (transient intensification of symptoms during first 24 hours of therapy) 1

Important Caveats

• Macrolides (azithromycin, clarithromycin, erythromycin) should be avoided as first-line therapy due to lower efficacy 1
• Prolonged antibiotic courses for persistent non-specific symptoms without objective evidence of active infection should be avoided 1
• Common side effects of doxycycline include photosensitivity, esophageal irritation, and gastrointestinal intolerance 1, 4
• Treatment failure is rare with standard courses of appropriate antibiotics 1, 2

Prophylaxis (Post-tick Exposure)

For prophylaxis after a tick bite (when indicated):

• Single dose of doxycycline: 200 mg for adults or 4.4 mg/kg (maximum 200 mg) for children ≥8 years 1
• Only indicated when specific criteria are met (Ixodes tick attached ≥36 hours, prophylaxis within 72 hours of removal, etc.) 1