From the Guidelines
The standard treatment for Lyme disease is antibiotics, with doxycycline (100 mg twice daily for 10-14 days) being the first-line treatment for adults, as recommended by the Infectious Diseases Society of America 1. For early localized Lyme disease, doxycycline is the preferred oral regimen, with amoxicillin (500 mg three times daily) and cefuroxime axetil (500 mg twice daily) being alternative options for adults and children who cannot take doxycycline.
- The dosage for children is 50 mg/kg per day in 3 divided doses (maximum, 500 mg per dose) for amoxicillin, and 30 mg/kg per day in 2 divided doses (maximum, 500 mg per dose) for cefuroxime axetil 1.
- Doxycycline is relatively contraindicated in pregnant or lactating women and in children under 8 years of age, and macrolide antibiotics are not recommended as first-line therapy for early Lyme disease 1. For more advanced Lyme disease with neurological involvement, intravenous antibiotics like ceftriaxone (2 g daily for 14-28 days) may be necessary, with the dosage for children being 50–75 mg/kg intravenously per day in a single dose (maximum, 2 g) 1.
- Patients with Lyme arthritis typically require longer courses of oral antibiotics, usually 28 days.
- Treatment should begin as soon as possible after diagnosis, as early intervention prevents progression to later stages of disease. Some patients may experience a Jarisch-Herxheimer reaction (temporary worsening of symptoms) when treatment begins as bacteria die off, but this typically resolves within 24-48 hours.
- Coinfection with other tick-borne illnesses, such as human granulocytic anaplasmosis or babesiosis, should be considered in patients with more severe initial symptoms or who do not respond to antibiotic therapy for Lyme disease 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
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 for Lyme Disease:
- Cefuroxime axetil 500 mg twice daily for 20 days is effective in treating early Lyme disease.
- The satisfactory clinical outcome was 91% for cefuroxime axetil and 93% for doxycycline at 1 month posttreatment.
- The clinical cure/success rate was 72% for cefuroxime axetil and 73% for doxycycline at 1 month posttreatment.
- Cefuroxime axetil and doxycycline were effective in preventing the development of sequelae of late Lyme disease 2.
From the Research
Treatment Options for Lyme Disease
- Oral amoxicillin and doxycycline are first-line treatment options for early stage Lyme borreliosis, as indicated by studies 3, 4, 5.
- Cefuroxime axetil is an alternative treatment option for children with early Lyme disease, as shown in a comparative study 3.
- For late or severe disease, intravenous ceftriaxone or penicillin G may be used, as suggested by 4 and 5.
- Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients, as mentioned in 4.
Antibiotic Efficacy
- Ceftriaxone and doxycycline are the most efficient antibiotics for treating Lyme arthritis and neuroborreliosis, according to 5.
- The efficacy of antibiotics in treating late Lyme borreliosis is less well-documented and may involve not only bacterial infection but also immunological response, as discussed in 5.