Lyme Disease Treatment Guidelines

Here are treatment guidelines for Lyme disease, as recommended in the Control of Infectious Diseases Manual by the American Public Health Association; these also coincide with the treatment guidelines proposed by the Centers for Disease Control and Prevention. For more information on Lyme disease see:

• Lyme disease profile
• Lyme disease symptoms
• Lyme disease diagnosis
• Lyme disease prevention
• Antibiotics for Lyme disease prevention
• Post Lyme disease syndrome definition

• The EM phase of Lyme disease is treated quite easily in adults with doxycycline (100mg twice a day or as prescribed by your doctor) or amoxicillin (500 mg three to four times daily or as prescribed by your doctor). This treatment will usually last around two weeks if EM is confined to one area of the body. Pregnant women should not take doxycycline, but otherwise should follow the same treatment as other adults.
• If EM has spread to other parts of the body, three to four weeks of antibiotic therapy may be prescribed by your doctor.
• Children under nine years old can take amoxicillin (for a total of 50mg/kg/day in more than one dose per day or as prescribed by your doctor) for the same number of weeks as for adults.
• Cefuroxime axetil or erythromycin may be used in patients allergic to penicillin or tetracyclines.
• Arthritis caused by Lyme disease can generally be treated with the oral antibiotics as described above, but in the case Lyme disease causes neurological disorders, except for only facial palsy, antibiotics such as ceftriaxone (2g once daily) or penicillin (20 m.u. in six separate doses for three to four weeks) may be administered intravenously. Check out Lyme arthritis treatment information from About.com’s guide to arthritis.
• Treatment is not always successful, so your doctor may re-treat you using the same or different drugs, but the CDC warns that second time around treatments that go longer than four weeks show no benefit to the patient and may even cause death. Re-treatment should only be considered after a break of up to several months in treatment because symptoms such as the swelling of joints can take months to clear up and re-treatment would not be necessary. Re-treatment of patients who have had symptoms for more than six months is not recommended. Physicians will likely look for other causes of continuing symptoms that may or may not be post-Lyme disease syndrome.

Treatment considerations

Allergies: If you are allergic to penicillin or tetracyclines, other antibiotics such as erythromycin and Cefuroxime axetil may be prescribed instead; these are also effective in treating Lyme disease.

About doxycycline: Doxycycline has the advantage of also treating another disease spread by ticks, called Human Granulocytic Anaplasmosis or HGA, which may infect a person at the same time as Lyme disease.

Disadvantages and warnings regarding doxycycline: Doxycycline does not treat the tick-borne disease called babesiosis. Pregnant women and children under eight years old should not take doxycycline. Also, those taking doxycycline should stay out of the sun or risk getting severely sunburned. Your doctor will prescribe another antibiotic if you cannot take doxycycline.

Researchers warn against treating Lyme disease in the following ways (extracted from Wormser et.al.):

Because of a lack of biologic plausibility, lack of efficacy, absence of supporting data, or the potential for harm to the patient, the following are not recommended for treatment of patients with any manifestation of Lyme disease: first-generation cephalosporins, fluoroquinolones, carbapenems, vancomycin, metronidazole, tinidazole, amantadine, ketolides, isoniazid, trimethoprim-sulfamethoxazole, fluconazole, benzathine penicillin G, combinations of antimicrobials, pulsed-dosing (i.e., dosing on some days but not others), long-term antibiotic therapy, anti-Bartonella therapies, hyperbaric oxygen, ozone, fever therapy, intravenous immunoglobulin, cholestyramine, intravenous hydrogen peroxide, specific nutritional supplements…magnesium and bismuth and others.

Basically this means that doctors, and anyone else for that matter, should not treat Lyme disease with certain antibiotics, drugs that kill parasites and fungi, or alternative therapies not approved for treating the disease. Be wary of websites that want to sell you a Lyme disease cure that looks too good to be true. It probably does not work and at worst may be dangerous.

_Sources

Chin, J. (2000.) Control of communicable diseases manual. Washington D.C.: American Public Health Association.

Centers for Disease Control. Division of Vector Borne Infectious Diseases. Lyme Disease. Learn About Lyme Disease.

Wormser, G. P. (2006). The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clinical Infectious Diseases, 43, Retrieved April 15, 2007.