Lyme Disease and Related Tick-Borne Infections - Treatment

A 2003 study suggested that a 10-day regimen of doxycycline was sufficient for curing most cases. The duration is a matter of some debate, since many doctors are concerned about persistent symptoms and so prescribe the antibiotic for 20 days. Whether prescribing antibiotics for longer periods of time adds any benefit, however, is uncertain and controversial. For example, according to the same 2003 study, extending the duration to 20 days did not prevent persistent Lyme symptoms any more effectively than the 10-day regimen.

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Side Effects of Antibiotics. The most common side effects of nearly all antibiotics are gastrointestinal problems, including cramps, nausea, vomiting, and diarrhea. Allergic reactions can also occur with all antibiotics, but are most common with medications derived from penicillin or sulfa. These reactions can range from mild skin rashes to rare but severe, even life-threatening, anaphylactic shock. Some drugs, including certain over-the-counter medications, interact with antibiotics; patients should report to the doctor all medications they are taking.

Treating Late Stage Lyme Disease

Lyme Arthritis. Either oral doxycycline (about 2 months) or intravenous ceftriaxone (1 month) are options for Lyme arthritis. The oral antibiotic has fewer side effects and is less expensive. Some patients on the oral medication, however, develop neurologic Lyme complications, which then require intravenous antibiotics. Newer potent oral antibiotics are under investigation. Patients should discuss these issues with their doctor.

Lyme Encephalopathy and Other Neurologic Symptoms. Intravenous (IV) antibiotic treatments (usually ceftriaxone) are typically used for 21 to 30 days. Good alternatives are intravenous cefotaxime or penicillin G. This treatment is nearly always successful in treating Lyme encephalopathy. Symptoms usually resolve in a week, but in some cases it can take months.

Heart Arrhythmia. Lyme disease, in some cases, effects the electrical conduction to the heart and can disrupt heart rhythms. Mild heart involvement usually responds to oral antibiotics. Severe disturbances in heart rhythms require intravenous antibiotics. Heart monitoring is important. For some patients, it may be necessary to insert a pacemaker for a week or two, although a permanent pacemaker is rarely needed.

Treating Post-Lyme Disease Syndrome

In about 10% of cases after treatment symptoms persist, a condition referred to as post-Lyme disease syndrome. In such cases, patients have persistent fatigue, muscle and joint aches, and neurologic symptoms. Treatment for this syndrome is highly controversial.