From the Guidelines
For a patient with a history of Lyme disease who has been bitten by another tick and now presents with erythema migrans, the recommended treatment is doxycycline 100 mg orally twice daily for 10-14 days, as it is the preferred antibiotic regimen according to the most recent guidelines 1. The treatment of erythema migrans, the characteristic rash of Lyme disease, is crucial to prevent progression to later stages of the disease, which can affect the heart, joints, and nervous system.
- Alternative options include amoxicillin 500 mg orally three times daily for 14-21 days, which is preferred for children under 8 and pregnant women, or cefuroxime axetil 500 mg orally twice daily for 14-21 days, which is suitable for those with penicillin allergy.
- Even with a previous Lyme infection, patients can be reinfected with Borrelia burgdorferi, the causative bacterium, from a new tick bite, as prior infection does not confer immunity 1.
- The patient should be monitored for resolution of symptoms and potential treatment side effects, and advised on tick prevention strategies for future protection, including wearing protective clothing, using insect repellents, and performing regular tick checks after outdoor activities.
- It is essential to note that doxycycline is relatively contraindicated during pregnancy or lactation and in children under 8 years of age, and alternative treatments should be considered in these cases 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 for Early Lyme Disease with Erythema Migrans:
- The patient can be treated with cefuroxime axetil 500 mg twice daily for 20 days or doxycycline 100 mg 3 times daily for 20 days.
- Both treatments have been shown to be effective in treating early Lyme disease and preventing the progression to late Lyme disease sequelae 2.
- The choice of treatment should be based on the patient's specific situation and medical history.
- It is essential to note that these treatments are for early Lyme disease with erythema migrans, and the patient's condition should be closely monitored.
From the Research
Treatment Options for Erythema Migrans
- Amoxicillin is a commonly used treatment for erythema migrans, with studies showing its efficacy in resolving the skin lesion and preventing the development of objective neurologic, cardiac, or rheumatologic manifestations 3.
- Cefuroxime axetil is also an effective treatment option, with comparable efficacy to doxycycline in adults with early Lyme disease 4, 5.
- Doxycycline is another treatment option, but its use is usually avoided in children due to toxicity concerns 4, 6.
- The recommended treatment duration is typically 2-4 weeks, with most patients recovering uneventfully 7.
Considerations for Treatment
- The choice of antibiotic should be based on the patient's age, medical history, and potential allergies or interactions 6.
- Routine antibiotic prophylaxis is not justified after a tick bite, even in an endemic area, as the risk of infection is low 6.
- Monitoring the skin around the bite and prescribing an antibiotic only if erythema migrans develops can help avoid unnecessary treatment and adverse effects 6.