What disease is resistant to azithromycin and ceftriaxone but sensitive to doxycycline?

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Last updated: March 21, 2025View editorial policy

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From the Guidelines

Lyme disease is resistant to azithromycin and ceftriaxone but sensitive to doxycycline, as evidenced by the treatment guidelines for Lyme disease, which recommend doxycycline as a first-line treatment option 1. The treatment of Lyme disease typically involves the use of antibiotics, with doxycycline being a preferred option due to its effectiveness against the causative agent, Borrelia burgdorferi.

  • The recommended dosage of doxycycline for adult patients is 200 mg orally per day, with a treatment duration of 14-21 days for early neurologic disease, and 28 days for late disease 1.
  • Azithromycin, on the other hand, is not a first-line treatment option for Lyme disease, and its use is generally reserved for patients who are intolerant of doxycycline and other preferred antibiotics 1.
  • Ceftriaxone, a third-generation cephalosporin, is also not a first-line treatment option for Lyme disease, although it may be used in certain cases, such as in patients with meningitis or other severe manifestations of the disease 1.
  • It is essential to note that the treatment of Lyme disease should be individualized, taking into account the patient's specific clinical manifestations, medical history, and other factors, and that the use of antibiotics should always be guided by evidence-based treatment guidelines 1.

From the Research

Disease Resistance and Sensitivity

  • The disease in question appears to be Lyme disease, caused by the bacterium Borrelia burgdorferi.
  • According to the studies, Borrelia burgdorferi is resistant to azithromycin and ceftriaxone in some cases, but sensitive to doxycycline 2, 3, 4, 5.
  • The in vitro susceptibility of Borrelia burgdorferi to various antimicrobial agents, including azithromycin, ceftriaxone, and doxycycline, has been studied, with results indicating that the bacterium is susceptible to doxycycline, but may be resistant to azithromycin and ceftriaxone in some cases 4, 5.
  • A study on the treatment of acute disseminated Lyme disease found that oral doxycycline and parenteral ceftriaxone were equally effective in preventing late manifestations of the disease, but did not address resistance to azithromycin 2.
  • Another study found that azithromycin and doxycycline were effective in treating erythema migrans, a skin lesion characteristic of Lyme disease, but that azithromycin may not be as effective in preventing later manifestations of the disease 3.
  • A more recent study found that combination antibiotic therapy, including doxycycline and ceftriaxone, was more effective in eradicating persistent Borrelia burgdorferi infections in mice than monotherapy with either antibiotic alone 6.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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