What is the treatment for a chronic Lyme disease (Lyme borreliosis) flare-up?

From the Guidelines

For the treatment of chronic Lyme disease flare-ups, doxycycline (100mg twice daily for 2-4 weeks) is recommended as the first-line treatment, with alternatives including amoxicillin (500mg three times daily) or cefuroxime (500mg twice daily) for those who cannot take doxycycline. The choice of antibiotic should be based on the patient's specific symptoms and medical history, as well as the potential for drug interactions and side effects 1.

Key Considerations

• The treatment of chronic Lyme disease should prioritize symptom management, including the use of anti-inflammatory medications like ibuprofen (400-800mg every 6-8 hours) for pain and inflammation, along with rest and adequate hydration.
• Complementary approaches such as physical therapy for joint pain, cognitive behavioral therapy for neurological symptoms, and stress reduction techniques may also be beneficial for some patients.
• The use of additional antibiotics for patients with persistent symptoms following standard treatment is not recommended, unless there is objective evidence of reinfection or treatment failure 1.
• In patients with Lyme arthritis, a second course of oral antibiotics or a 2-4 week course of IV ceftriaxone may be considered for those with partial or no response to initial treatment, respectively 1.

Treatment Approach

• The treatment approach should be individualized based on the patient's specific symptoms and medical history.
• Patients should be closely monitored for response to treatment and potential side effects.
• The use of antibiotics should be guided by the principles of antimicrobial stewardship, with the goal of minimizing the risk of antibiotic resistance and promoting optimal patient outcomes.
• Patients with persistent symptoms should be evaluated for other potential causes of their symptoms, and treatment should be adjusted accordingly 1.

From the FDA Drug Label

Doxycycline is indicated for the treatment of infections caused by the following gram-negative microorganisms: ... Relapsing fever due to Borrelia recurrentis. The treatment for Chronic Lyme flare up is not directly mentioned in the label, but Relapsing fever due to Borrelia recurrentis is mentioned as an indication for doxycycline. However, Lyme disease is caused by Borrelia burgdorferi, not Borrelia recurrentis.

• The FDA label does not explicitly address Chronic Lyme flare up treatment. Therefore, no conclusion can be drawn about the use of doxycycline for Chronic Lyme flare up treatment 2.

From the Research

Treatment Options for Chronic Lyme Flare Up

• The treatment for chronic Lyme disease is typically with oral antibiotics, such as amoxicillin or doxycycline, for 3 to 4 weeks 3.
• In some cases, intravenous antibiotics, such as ceftriaxone or penicillin, may be necessary for 2 to 3 weeks 3.
• A study comparing ceftriaxone and doxycycline for the treatment of acute disseminated Lyme disease found that both treatments were highly effective, with similar rates of clinical cure 4.
• 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, while cefuroxime and penicillin were safe for treating the disease 5.

Special Considerations

• Patients with isolated facial seventh cranial nerve palsy may be treated with oral therapy, although some physicians may prescribe concomitant corticosteroids to hasten the resolution of the palsy 3.
• Patients with persistent symptoms, such as fibromyalgia, may require special care to determine if the symptoms are caused by a process that is no longer antibiotic-sensitive 3.
• A review of treatment options for Lyme borreliosis noted that inadequate penetration of oral agents into the CNS may result in the development of overt neuroborreliosis, and that parenteral agents, such as ceftriaxone, may be necessary for severe acute and chronic infections 6.

Diagnosis and Prophylaxis

• Diagnosis of Lyme disease is usually made clinically, and treatment is typically started promptly to prevent the development of later stages of the disease 7.
• Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients to prevent the development of Lyme disease after a tick bite 7.
• Preventive measures, such as avoiding tick bites and using insect repellents, should be emphasized to patients to help reduce the risk of Lyme disease 7.