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 best antibiotic for Lyme disease is not explicitly stated in the label, but doxycycline is indicated for the treatment of relapsing fever due to Borrelia recurrentis, which is a similar condition. However, the label does not directly address Lyme disease.
- Key points:
- Doxycycline is used to treat various bacterial infections.
- The label does not explicitly mention Lyme disease.
- Doxycycline is used for relapsing fever due to Borrelia recurrentis, a similar condition. 1
From the Research
Introduction to Lyme Disease
Lyme disease is a multisystem inflammatory disease caused by infection with Borrelia burgdorferi, typically transmitted through a tick bite. The disease can manifest in various stages, including early localized, early disseminated, and late disseminated stages.
Treatment of Lyme Disease
The treatment of Lyme disease depends on the stage of the disease. For early localized Lyme disease, oral antibiotics are usually sufficient. The recommended antibiotics include:
- Amoxicillin (500 mg 3 or 4 times daily) with or without probenecid 500 mg 3 times daily 2
- Doxycycline (100 mg twice daily) 2, 3, 4
- Cefuroxime axetil (500 mg twice daily) 3
- Azithromycin (500 mg/day for 7-10 days) 3
Dosage and Duration
The dosage and duration of antibiotic treatment vary depending on the patient's age and the stage of the disease. For example:
- Adults with early localized Lyme disease can be treated with amoxicillin (50 mg/kg/day in 3 intakes) or doxycycline (100 mg bid) for 14 days (erythema migrans) to 21 days (early localized Lyme disease with associated symptoms) 3
- Children above 8 years of age can be treated with amoxicillin (50 mg/kg/day in 3 intakes) or doxycycline (4 mg/kg/day in 2 intakes, maximum 100 mg/dose) 3
- For Lyme arthritis, doxycycline (1 × 200 or 2 × 100 mg for 30 days) is the antibiotic agent of choice, with amoxicillin (3 × 500-1000 mg) as an alternative 4
Special Considerations
There are certain situations that require special consideration, such as:
- Patients with isolated facial seventh cranial nerve palsy, who can be treated with oral therapy, but may also receive concomitant corticosteroids to hasten the resolution of the palsy 2
- Patients with persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, who should be treated intravenously with ceftriaxone at 2 g per day for 14-21 days 4
- Patients with "chronic Lyme disease", who may require special care to avoid prolonged or unending courses of antibiotics for noninfectious problems 2
Conclusion
The best antibiotic for Lyme disease depends on the stage of the disease and the patient's age. Doxycycline and amoxicillin are commonly used antibiotics for early localized Lyme disease, while ceftriaxone is used for more severe cases, such as Lyme arthritis. It is essential to follow the recommended dosage and duration of treatment to ensure effective treatment and avoid unnecessary antibiotic use.