From the Guidelines
The first line treatment for Lyme disease is doxycycline, typically prescribed at 100 mg twice daily for 10-14 days for early localized or early disseminated Lyme disease without neurologic involvement. For children under 8 years old, amoxicillin is preferred at 50 mg/kg/day divided into three doses (maximum 500 mg per dose) for the same duration 1. Alternative options for adults with doxycycline allergies include amoxicillin 500 mg three times daily or cefuroxime axetil 500 mg twice daily for 14 days. Treatment should begin as soon as Lyme disease is suspected, even before laboratory confirmation in cases with typical erythema migrans rash in endemic areas. Doxycycline is particularly effective because it treats not only Borrelia burgdorferi (the Lyme disease bacterium) but also potential co-infections like Anaplasma. Patients should be advised that doxycycline causes photosensitivity, so sun protection is necessary, and it should be taken with food to minimize gastrointestinal side effects. For more severe manifestations like cardiac or neurologic Lyme disease, intravenous antibiotics or longer treatment courses may be required.
Some key points to consider when treating Lyme disease include:
- Doxycycline is the preferred treatment for adults and children over 8 years old due to its effectiveness against Borrelia burgdorferi and potential co-infections like Anaplasma 1.
- Amoxicillin is a suitable alternative for children under 8 years old and adults with doxycycline allergies 1.
- Cefuroxime axetil is another alternative option for adults with doxycycline allergies 1.
- Macrolide antibiotics are not recommended as first-line therapy due to their lower efficacy compared to doxycycline, amoxicillin, and cefuroxime axetil 1.
- Treatment should be started promptly, even before laboratory confirmation, in cases with typical erythema migrans rash in endemic areas 1.
It's essential to note that the treatment of Lyme disease should be individualized based on the patient's specific condition, age, and other factors. The guidelines provided by the Infectious Diseases Society of America should be consulted for more detailed information on the treatment of Lyme disease 1.
From the Research
First Line Treatment for Lyme Disease
- The first line treatment for Lyme disease includes oral amoxicillin and doxycycline, as recommended by studies 2, 3, 4.
- Amoxicillin is recommended at a dose of 50 mg/kg/day in 3 intakes for 14-21 days for adults and children 2.
- Doxycycline is recommended at a dose of 100 mg bid for 14-21 days for adults and 4 mg/kg/day in 2 intakes for children above 8 years of age 2.
Alternative Treatments
- Cefuroxime axetil and azithromycin are considered alternative second-line treatment options for Lyme disease 2, 4.
- Ceftriaxone and penicillin are also effective for treating Lyme disease, particularly in cases of Lyme arthritis and neuroborreliosis 4, 5.
Treatment Efficacy and Safety
- A network meta-analysis of 31 randomized controlled trials found that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease 5.
- The same study found that cefuroxime and penicillin were safe for treating Lyme disease, while amoxicillin was effective for treating erythema migrans 5.
- Another study found that parenteral ceftriaxone and oral doxycycline were equally effective in preventing late manifestations of disease in patients with acute disseminated Lyme disease 6.