From the Research
For Lyme disease prophylaxis in patients allergic to doxycycline, amoxicillin 1.5 g/day is the most effective alternative, as shown in a recent network meta-analysis 1. When considering alternatives to doxycycline for Lyme disease prophylaxis, it's essential to weigh the efficacy and safety of different antibiotics.
- Amoxicillin is generally preferred as the first alternative, but should be avoided in patients with penicillin allergies.
- Azithromycin is less effective than doxycycline but can be used when both doxycycline and amoxicillin are contraindicated.
- Cefuroxime axetil and ceftriaxone are also effective options, but their use may be limited by potential side effects and the need for injectable administration, respectively. Prophylaxis should only be given if the tick was attached for at least 36 hours, was identified as an Ixodes tick, and was removed within the past 72 hours in an area where Lyme disease is endemic.
- If you have a history of severe allergic reaction to doxycycline, do not attempt desensitization without specialist supervision.
- Remember that prophylaxis reduces but doesn't eliminate the risk of Lyme disease, so monitor for symptoms like erythema migrans (bull's-eye rash), fever, fatigue, headache, and joint pain for several weeks after a tick bite. The most recent and highest quality study, a network meta-analysis published in 2021 1, provides the strongest evidence for the efficacy of amoxicillin in treating Lyme disease, making it the preferred alternative to doxycycline.