From the Guidelines
Lyme disease should be treated promptly with antibiotics, with doxycycline 100mg twice daily for 10-14 days being the first-line treatment for adults, and amoxicillin 50mg/kg/day divided into three doses for 14-21 days for children under 8 years old. The treatment approach may vary depending on the stage and severity of the disease, with more disseminated disease requiring longer treatment durations of 14-21 days, and Lyme arthritis or neurological involvement requiring treatment for 28 days 1.
Key Considerations
- The bacterium Borrelia burgdorferi causes Lyme disease, and if left untreated, it can spread to joints, the heart, and the nervous system, causing more serious complications.
- Prevention is crucial and includes wearing protective clothing in wooded areas, using insect repellent containing DEET, checking for ticks after outdoor activities, and removing attached ticks promptly with fine-tipped tweezers.
- For patients with a recognized tick bite, routine use of antimicrobial prophylaxis or serologic testing is not recommended, but a single dose of doxycycline may be offered to adult patients and to children 8 years of age under certain circumstances 1.
- The diagnosis of Lyme disease can be made based on clinical presentation, laboratory tests, and epidemiological information, with a two-tier testing approach using enzyme immunoassay (EIA) and Western blot (WB) being the recommended diagnostic method 1.
Treatment Approach
- For early localized disease, doxycycline 100mg twice daily for 10-14 days is the first-line treatment for adults.
- For children under 8 years old, amoxicillin 50mg/kg/day divided into three doses for 14-21 days is recommended.
- For more disseminated disease, treatment may extend to 14-21 days.
- In cases of Lyme arthritis or neurological involvement, treatment may last 28 days.
Prevention and Control
- Wearing protective clothing in wooded areas, using insect repellent containing DEET, checking for ticks after outdoor activities, and removing attached ticks promptly with fine-tipped tweezers can help prevent Lyme disease.
- Healthcare practitioners should become familiar with the clinical manifestations and recommended practices for diagnosing and treating Lyme disease, and persons who have removed attached ticks from themselves should be monitored closely for signs and symptoms of tickborne diseases for up to 30 days 1.
From the Research
Overview of Lyme Disease
- Lyme disease is the most common tick-borne disease in the United States, with approximately 20,000 cases reported annually 2.
- The disease is transmitted to humans through the bite of the Ixodes tick (Ixodes scapularis and Ixodes pacificus) 2, 3.
- Residents of the coastal Northeast, northwest California, and the Great Lakes region are at highest risk, as well as children and those spending extended time outdoors in wooded areas 2.
Clinical Presentation and Diagnosis
- The disease has three stages, each with specific clinical features: early localized infection, early disseminated infection, and late disseminated infection 2.
- Diagnosis is usually made clinically, with identification of an erythema migrans rash following a tick bite being the only clinical manifestation sufficient to make the diagnosis in the absence of laboratory confirmation 3.
- The Centers for Disease Control and Prevention recommends a two-tier serologic testing protocol using an enzyme-linked immunosorbent assay initially, followed by the more specific Western blot to confirm the diagnosis when the assay samples are positive or equivocal 3.
Treatment and Prophylaxis
- Treatment is accomplished with doxycycline or amoxicillin, with cefuroxime axetil or erythromycin as alternative options 2.
- Late or severe disease requires intravenous ceftriaxone or penicillin G 2.
- Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients 2.
- A network meta-analysis 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 4.
- Another study found that longer-term antibiotic treatment did not have additional beneficial effects on health-related quality of life beyond those with shorter-term treatment 5.