What is the recommended prophylactic treatment for Lyme disease (Lyme borreliosis)?

From the Guidelines

Prophylactic treatment for Lyme disease with a single dose of oral doxycycline within 72 hours of tick removal is recommended for high-risk Ixodes spp. bites in all age groups. This approach is supported by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) guidelines, which suggest that doxycycline be given as a single oral dose, 200 mg for adults and 4.4 mg/kg (up to a maximum dose of 200 mg) for children 1. The guidelines emphasize that prophylactic antibiotic therapy should only be given to adults and children within 72 hours of removal of an identified high-risk tick bite, but not for bites that are equivocal risk or low risk 1. It is essential to note that prophylaxis is not necessary for all tick bites, only those where the tick is identified as an Ixodes species (deer tick), was likely attached for more than 36 hours, and in an area where Lyme disease is common.

Some key points to consider when administering prophylactic treatment for Lyme disease include:

• The tick bite must be from an Ixodes species (deer tick) and attached for more than 36 hours
• The bite must be in an area where Lyme disease is common
• The prophylactic treatment should be administered within 72 hours of tick removal
• Doxycycline is the recommended antibiotic for prophylaxis, given as a single oral dose of 200 mg for adults and 4.4 mg/kg (up to a maximum dose of 200 mg) for children
• Prophylaxis is not recommended for pregnant women or those allergic to doxycycline, instead, careful monitoring for symptoms is advised 1.

If symptoms of Lyme disease develop despite prophylaxis, such as the characteristic bull's-eye rash, fever, headache, or joint pain, a full treatment course of antibiotics would then be necessary.

From the FDA Drug Label

Prophylaxis: Doxycycline is indicated for the prophylaxis of malaria due to Plasmodium falciparum in short-term travelers (<4 months) to areas with chloroquine and/or pyrimethamine-sulfadoxine resistant strains

• No information is provided in the drug label about prophylactic Lyme treatment. The FDA drug label does not answer the question.

From the Research

Prophylactic Lyme Treatment

• The efficacy and safety of antibiotics for treating Lyme disease is still controversial 2.
• A network meta-analysis found that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease, while cefuroxime and penicillin were safe for treating the disease 2.
• Another study compared parenteral ceftriaxone with oral doxycycline for the treatment of acute disseminated Lyme disease and found that both treatments were highly effective, with similar rates of clinical cure 3.

Antibiotic Treatment Options

• Oral amoxicillin and doxycycline are first-line treatment options for early stage Lyme borreliosis, while phenoxymethylpenicillin, cefuroxime axetil, and azithromycin are alternative second-line options 4.
• Ceftriaxone and doxycycline are the most efficient antibiotics for treating Lyme arthritis and neuroborreliosis, but are less efficient in late Lyme borreliosis 4.
• A study found that daptomycin-containing drug combinations, such as daptomycin plus doxycycline and cefoperazone, were effective in eradicating Borrelia burgdorferi persisters in vitro 5.

Treatment of Neurological Complications

• A systematic review found that there is mostly low- to very low-quality clinical evidence on the relative efficacy of central nervous system-penetrant antibiotics for the treatment of Lyme neuroborreliosis 6.
• The review found that doxycycline, penicillin G, ceftriaxone, and cefotaxime are efficacious in the treatment of European Lyme neuroborreliosis, but there is a lack of evidence on the efficacy of antibiotics for treatment of Lyme neuroborreliosis in the United States 6.