What is the treatment for suspected Lyme disease in a 63-year-old female?

From the Guidelines

For suspected Lyme disease in a 63-year-old female, the recommended treatment is doxycycline 100 mg orally twice daily for 10-14 days, as it is the most effective first-line therapy for early localized or early disseminated Lyme disease without neurologic involvement, according to the Infectious Diseases Society of America guidelines 1. This recommendation is based on the guidelines that suggest doxycycline, amoxicillin, or cefuroxime axetil for 14 days (range for doxycycline, 10–21 days; range for amoxicillin or cefuroxime axetil, 14–21 days) is recommended for treatment of adult patients with early localized or early disseminated Lyme disease associated with erythema migrans in the absence of specific neurologic manifestations 1. Some key points to consider when treating Lyme disease include:

• Doxycycline has the advantage of being effective for treatment of HGA (but not for babesiosis), which may occur simultaneously with early Lyme disease 1.
• Doxycycline is relatively contraindicated during pregnancy or lactation and in children under 8 years of age, but this is not a concern for a 63-year-old female 1.
• Macrolide antibiotics are not recommended as first-line therapy for early Lyme disease, and should be reserved for patients who are intolerant of, or should not take, amoxicillin, doxycycline, and cefuroxime axetil 1.
• Patients treated with doxycycline should be advised to avoid exposure to the sun while receiving therapy, and to take the medication with 8 ounces of fluid to reduce the risk of esophageal irritation and with food to reduce gastrointestinal intolerance 1.

From the FDA Drug Label

Two adequate and well-controlled studies were performed in patients with early Lyme disease. In these studies all patients had to present with physician-documented erythema migrans, with or without systemic manifestations of infection Patients were randomized in a 1:1 ratio to a 20-day course of treatment with cefuroxime axetil 500 mg twice daily or doxycycline 100 mg 3 times daily.

The efficacy data summarized below are specific to this “validated” patient subset, while the safety data summarized below reflect the entire patient population for the 2 studies

Analysis of the submitted clinical data for evaluable patients in the “validated” patient subset yielded the following results:

Table 7: Clinical Effectiveness of Cefuroxime Axetil Tablets Compared to Doxycycline in the Treatment of Early Lyme Disease

Part I (1 Month Posttreatment)* Part II (1 Year Posttreatment)† Cefuroxime Axetil Doxycycline Cefuroxime Axetil Doxycycline (n = 125) (n = 108) (n = 105‡) (n = 83‡) Satisfactory clinical outcome§ 91% 93% 84% 87% Clinical cure/success 72% 73% 73% 73% Clinical improvement 19% 19% 10% 13%

Treatment of Early Lyme Disease:

• Cefuroxime axetil 500 mg twice daily for 20 days is a treatment option for early Lyme disease.
• The clinical effectiveness of cefuroxime axetil is comparable to doxycycline.
• Key points:
  • Satisfactory clinical outcome: 91% for cefuroxime axetil and 93% for doxycycline at 1 month posttreatment.
  • Clinical cure/success: 72% for cefuroxime axetil and 73% for doxycycline at 1 month posttreatment.
  • Clinical improvement: 19% for cefuroxime axetil and 19% for doxycycline at 1 month posttreatment. 2

From the Research

Treatment Options for Lyme Disease

• The treatment for Lyme disease typically involves the use of antibiotics, with doxycycline or amoxicillin being the most commonly recommended options 3.
• Alternative treatments include cefuroxime axetil or erythromycin, while late or severe disease may require intravenous ceftriaxone or penicillin G 3.
• 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 4.

Specific Treatment Regimens

• A study comparing two treatment regimens of ceftriaxone in late Lyme disease found that a 14-day course was effective in eradicating the signs and symptoms of the disease in the majority of patients, although there were more failures in the 14-day group than in the 28-day group 5.
• The Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) have developed clinical practice guidelines for the prevention, diagnosis, and treatment of Lyme disease, which include recommendations for treatment regimens 6.

Considerations for Treatment

• The choice of treatment regimen may depend on the stage and severity of the disease, as well as the patient's individual circumstances and medical history.
• It is essential to note that the treatment of Lyme disease should be guided by clinical practice guidelines and the advice of a healthcare professional 6.
• Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients, although this should be determined on a case-by-case basis 3.