What is the treatment for Lyme disease?

Treatment for Lyme Disease

First-line treatment for Lyme disease includes doxycycline, amoxicillin, or cefuroxime axetil, with specific dosing regimens based on disease stage and patient characteristics. 1

Antibiotic Treatment Options

Early Lyme Disease (Erythema Migrans)

• Recommended oral antibiotics (10-14 days):
  • Doxycycline: 100 mg twice daily for adults; 4 mg/kg/day in 2 divided doses (max 100 mg per dose) for children ≥8 years 1
  • Amoxicillin: 500 mg three times daily for adults; 50 mg/kg/day in 3 divided doses (max 500 mg per dose) for children 1
  • Cefuroxime axetil: 500 mg twice daily for adults; 30 mg/kg/day in 2 divided doses (max 500 mg per dose) for children 1, 2

Neurological Manifestations

• For meningitis or radiculopathy:
  • IV ceftriaxone 2g daily for 14 days (range 10-28 days) 1
• For facial nerve palsy without CSF abnormalities:
  • Oral regimen as for erythema migrans for 14 days 1
• For facial nerve palsy with CSF abnormalities:
  • Treatment as for meningitis 1

Lyme Arthritis

• Initial treatment:
  • Same oral regimens as for early disease, but for 28 days 1
• For persistent arthritis:
  • Second course of oral antibiotics for up to 1 month for mild residual joint swelling 1
  • IV ceftriaxone 2g daily for 2-4 weeks for moderate to severe joint swelling with minimal response 1

Clinical Evidence and Efficacy

Clinical trials have demonstrated comparable effectiveness between cefuroxime axetil and doxycycline in treating early Lyme disease. In validated patient subsets, both treatments showed approximately 91-93% satisfactory clinical outcomes at 1 month post-treatment and 84-87% at 1 year post-treatment 2.

Post-Treatment Considerations

For patients with persistent symptoms following appropriate treatment:

• Focus on symptomatic management with non-antibiotic approaches 1
• Additional antibiotic therapy is not recommended for persistent symptoms without objective evidence of active infection 1
• Consider NSAIDs, physical therapy, cognitive behavioral therapy for pain management 1
• For persistent arthritis, refer to a rheumatologist for consideration of DMARDs, biologic agents, intraarticular steroid injections, or arthroscopic synovectomy 1

Special Populations

• Children under 8 years: Avoid doxycycline; use amoxicillin or cefuroxime axetil 1
• Pregnant women: Avoid doxycycline; amoxicillin is preferred

Common Pitfalls to Avoid

1. Overtreatment with antibiotics beyond recommended durations provides no additional benefit and increases risk of adverse effects 1
2. Misinterpreting persistent symptoms as requiring additional antibiotics when they may represent post-Lyme disease syndrome 1
3. Neglecting psychological aspects of chronic pain, which can significantly impact patient well-being 1
4. Delaying non-antibiotic management in patients who have failed appropriate antibiotic courses 1

Prophylaxis After Tick Bite

Prophylaxis is recommended only for high-risk tick bites meeting all criteria:

• Identified Ixodes spp. vector tick
• Tick attached for ≥36 hours
• Prophylaxis started within 72 hours of tick removal
• Local infection rate of ticks with B. burgdorferi ≥20%

When indicated, use single-dose doxycycline: 200 mg for adults; 4.4 mg/kg (maximum 200 mg) for children ≥8 years 1