From the Guidelines
The recommended treatment for Lyme disease is doxycycline 100mg twice daily for 10-14 days for adults with early localized Lyme disease, as it is the most effective and well-tolerated option, according to the Infectious Diseases Society of America guidelines 1.
Treatment Options
For early localized Lyme disease (single erythema migrans rash), the following treatment options are recommended:
- Doxycycline 100mg twice daily for 10-14 days for adults
- Amoxicillin 500mg three times daily for 14-21 days for adults
- Cefuroxime axetil 500mg twice daily for 14-21 days for adults
- For children, amoxicillin 50mg/kg/day divided into three doses (maximum 500mg per dose) for 14-21 days is preferred, though doxycycline can be used for children over 8 years old 1
Special Considerations
For early disseminated or late Lyme disease with multiple rashes, cardiac or neurological involvement, oral doxycycline may be extended to 14-21 days 1. Severe cases with heart block, meningitis, or late manifestations like arthritis may require intravenous ceftriaxone 2g daily for 14-28 days 1.
Rationale
The antibiotics work by targeting the causative bacterium Borrelia burgdorferi, preventing its replication and allowing the immune system to clear the infection. Most patients recover completely with appropriate and timely antibiotic treatment, though some may experience post-treatment symptoms that typically resolve over time 1.
Key Points
- Treatment should begin immediately after diagnosis, as delaying therapy can lead to more severe disease progression
- Doxycycline is relatively contraindicated in children under 8 years old and in women who are pregnant or breast-feeding
- Macrolide antibiotics are not recommended as first-line therapy for early Lyme disease, but may be used as an alternative in patients who are intolerant of other antibiotics 1
From the Research
Treatment Guidelines for Lyme Disease
The treatment of Lyme disease (Lyme borreliosis) depends on the stage and severity of the disease.
- For early localized Lyme disease, oral antibiotics such as amoxicillin, doxycycline, and cefuroxime axetil are recommended 2, 3, 4, 5.
- The duration of treatment for early localized Lyme disease is typically 14 to 21 days 4, 5.
- For later stages of Lyme disease, such as neurological disease, carditis, and arthritis, intravenous antibiotics such as ceftriaxone, cefotaxime, and penicillin G may be necessary 2, 3.
- The treatment of chronic, non-specific disorders, such as posttreatment Lyme disease syndrome and "chronic Lyme disease", is a major challenge and requires careful diagnosis and management 6.
Antibiotic Options
The following antibiotics are commonly used to treat Lyme disease:
- Amoxicillin (500 mg 3 or 4 times daily) 2, 4, 5
- Doxycycline (100 mg twice daily) 2, 3, 4, 6, 5
- Cefuroxime axetil (500 mg twice daily) 3, 4, 5
- Ceftriaxone (1 g every 12 hours or 2 g every day) 2, 3
- Penicillin G (14 g in divided doses) 2, 3
Special Considerations
- Patients with isolated facial seventh cranial nerve palsy may be treated with oral antibiotics, but some physicians may prescribe concomitant corticosteroids to hasten the resolution of the palsy 2.
- Premature antibiotic administration can mask important diagnostic signs, and careful diagnostic work-up is necessary before starting treatment 3.