Treatment

The standard treatment for Lyme disease is oral antibiotics.  The first line antibiotic used is typically doxycycline.  This is because doxycycline is also active against another agent that can be co-transmitted, Anaplasma phagocytophilum, and also because, of the oral antibiotics, doxycycline achieves the highest level in the brain where the bacteria often hide.

There are side effects to doxycycline.  The most common is one called photosensitivity, which is a fancy way of saying that if you go out into the sun while taking doxycycline, you could end up with a really bad sunburn.  Doxycycline did not used to be recommended for children under 8 over fears of it discoloring their teeth the way a related drug, tetracycline, does.  However, it turns out that doxycycline is more like a distant cousin than a sister so now it is okay for children to take doxycycline for a couple of weeks.

If you really can’t take doxycycline, your doctor may prescribe a different antibiotic.  Other commonly used antibiotics include: amoxicillin, cefuroxime (Ceftin), and azithromycin.  All of these antibiotics work well and the majority of people taking any of these antibiotics improve on treatment.

There are rare times when your doctor may prescribe an antibiotic that is given intravenously (directly into the blood stream).  Intravenous antibiotics are used for more severe infections, because there is less variability in the levels of antibiotic that get into your blood and because the most commonly used drug, called ceftriaxone, is very effective at killing the Lyme disease causing bacteria.  Times where an intravenous antibiotic may still be used are: 1). if you require hospitalization (for example for Lyme disease that affects the heart or your brain).  In this case, your doctor may start with intravenous ceftriaxone, but change you to an oral antibiotic once you are better and ready to go home.  2). If you didn’t improve on oral antibiotics.  Some symptoms with Lyme appear more difficult to treat—for example Lyme arthritis.  In the case of non-improving arthritis, some doctors will give a 3-4 week course of treatment with ceftriaxone.  Ceftriaxone should not be used for patients with residual symptoms like fatigue or muscle aches as it has not been shown to improve these types of symptoms.

cdc.gov