From the Guidelines
Doxycycline should be prescribed at 100 mg twice daily for 10-14 days for the treatment of erythema migrans in adults with uncomplicated early Lyme disease. This recommendation is based on the most recent and highest quality study available, which suggests that doxycycline is effective in treating erythema migrans and preventing progression to later stages of the disease 1. The dosage and duration of treatment are consistent with the guidelines provided by the Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology 1.
Key Considerations
- Doxycycline is the preferred antibiotic for the treatment of erythema migrans due to its effectiveness against Borrelia burgdorferi and its ability to inhibit bacterial protein synthesis 1.
- The recommended dosage of doxycycline is 100 mg twice daily, which can be taken with a full glass of water and with food if stomach upset occurs 1.
- Patients should be advised to remain upright for 30 minutes after taking doxycycline to prevent esophageal irritation and to use sun protection during treatment due to increased sun sensitivity 1.
- Alternative antibiotics, such as amoxicillin or cefuroxime axetil, may be used in patients who are unable to take doxycycline, but azithromycin is recommended as a second-line agent only if both doxycycline and beta-lactam antibiotics are contraindicated 1.
Special Considerations
- Children weighing less than 45 kg should receive 2.2 mg/kg twice daily (up to the adult dose) of doxycycline, but doxycycline is relatively contraindicated in children under 8 years of age and in women who are pregnant or breast-feeding 1.
- Patients with specific neurologic manifestations or advanced atrioventricular heart block may require alternative treatment approaches, which should be guided by a healthcare professional 1.
From the Research
Dosing for Doxy Erythema Migrans Lyme Rash
- The recommended dosing for doxycycline in the treatment of erythema migrans Lyme rash is 100 mg bid for 14 days 2.
- A study comparing doxycycline and tetracycline for the treatment of Lyme disease associated with erythema migrans found that doxycycline 100 mg two or three times a day for 14 days was effective, with no significant difference in efficacy or safety compared to tetracycline 3.
- However, a network meta-analysis of 31 randomized controlled trials found that doxycycline did not have a significant advantage in efficacy and safety for treating Lyme disease, including erythema migrans, compared to other antibiotics such as amoxicillin and azithromycin 4.
- Another study found that oral amoxicillin or doxycycline can prevent progression of the infection to the potentially severe, later stages of Lyme disease, but doxycycline should not be used to treat pregnant or breast-feeding women, or children under 8 years old, due to a risk of tooth and bone disorders in children 5.
Alternative Treatment Options
- Amoxicillin is an alternative treatment option for erythema migrans Lyme rash, with a recommended dosing of 50 mg/kg/day in 3 intakes for 14 days 2.
- A study found that a 14-day course of amoxicillin, 500 mg 3 times daily, was highly effective therapy for patients with early Lyme disease 6.
- Other antibiotics such as cefuroxime and azithromycin may also be effective, but may have lower efficacy or more adverse effects compared to amoxicillin and doxycycline 2, 4, 5.