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Lyme Disease
Treatment
s treatable at all stages, with either oral or intravenous antibiotics.
complexity in the treatment decisions, and these differ somewhat
d adults. There have been few randomized clinical trials of
optimal choice of antibiotic or optimal duration of treatment are not
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ral, early Lyme disease in adults is treated with doxycycline 100 mg
ily or amoxicillin 500 mg orally three times daily for 20 to 30 days.
ould not be used in children under age nine years or pregnant
r antibiotic choices include phenoxymethyl penicillin, tetracycline,
etil, erythromycin, or azithromycin, with the latter two considered to
adelman, et.al., they compared treatment with placebo versus a
dose of doxycycline in 482 subjects who had removed attached I.
from their bodies within the previous 72 hours. Erythema migrans
he site of the tick bite in a signicantly smaller proportion of the
doxycycline group than of those in the placebo group (1 of 235
ercent] vs. 8 of 247 subjects [3.2 percent], P<0.04). The efcacy of
87 percent (95 percent condence interval, 25 to 98 percent).
acutaneous signs of Lyme disease did not develop in any subject,
e no asymptomatic seroconversions. These data suggest that
-mg dose of doxycycline given within 72 hours after
aris tick bite can prevent the development of Lyme
r 30 day courses has been used to treat certain cardiac, nervous
int manifestations of Lyme disease. Other specic manifestations of
re generally treated with intravenous antibiotics, most often
m twice daily for 14 to 30 days, and these include Lyme meningitis,
is, arthritis not responsive to doxycycline, and severe cardiac
elief after treatment should be evaluated not on a day-to-day basis,
r several months. Patients should have slow, steady progress to their
te. Patients who have lingering symptoms after treatment should not
treated with antibiotics without clear evidence of antibiotic failure.
anti-inammatory medications, anti-depressants, exercise, and
y have been used for symptomatic relief after an adequate trial of
atment Regimens for Lyme Disease*
(Local or Disseminated)
Doxycycline, 100 mg orally 2 times/days(d) for 20 to 20d
Amoxicillin, 500 mg orally 3 times/d for 20 to 30dAlternatives in
case of doxycycline or amoxicillin allergy:
Cefuroxime axetil, 500 mg orally twice daily for 20 to 30d
Erythromycin, 150 mg orally 4 times a day or 20 mg/kg/d in
divided doses for 20 to 20d
Amoxicillin, 250 mg orally 3 times a day or 20 mg/kg/d in
divided doses for 20 to 30 dAlternatives in case of penicillin
Cefuroxime axetil, 125 mg orally twice daily for 20 to 30 d
Erythromycin, 250 mg orally 3 times a day or 30 mg/kg/d in
divided doses for 20 to 20 d
Doxycycline 100 mg orally 2 times/d for 30 to 60d
Amoxicilln 500 mg orally 4 times/d for 30 to 60d
Ceftriaxone 2g IV once a day for 14 to 39d
Penicillin G, 20 million U IV in 4 divided doses daily for 30d
Ceftriaxone 2g IV once a day for 14 to 30d
Penicillin G, 20 million U IV in 4 divided doses for 30
Alternative in case of ceftriaxone or penicillin allergy:
Doxycycline, 100 mg orally 3 times a day for 30d
Oral regimens may be adequate
Oral regimens, as for early infection
Ceftriaxone, 2 gm IV once a day for 30d**
Penicillin G, 20 million U IV in 4 divided doses daily for 30d**
Infectious Disease Society of America
lures have occurred with any of the regimens given, and a second
tient has stabilized, the course may be completed with oral therapy.
How can individuals protect
uld be educated to check themselves, very carefully, at the end of
k-infested habitats, for ticks on their skin. Any ticks should be
iscarded. Since I. scapularis must feed for 24-48 hours to transmit
is will likely prevent most, if not all, Lyme disease. Other behaviors,
(n,n-diethyl-m-toluamide) use on skin (an insect repellent) or
e on clothing (an insecticide, which kills ticks, derived from owers
his use), tucking pants into socks, wearing long sleeves and long
ring light-colored clothing for easier spotting of ticks, can also be
ill argue that such personal protective behaviors have not been
o decrease the risk of Lyme disease. However, a growing body of
evidence, albeit indirect, suggests that such behaviors are benecial
ersons from tick bites and thus Lyme disease. Such environmental
s elimination of leaf litter, deer exclusion with fencing, deer
ecticide (acaricide) applications, and even the use of guinea fowl
me, have been shown, in some instances, to decrease tick burden
tial areas. However, there are not really any practical environmental
event Lyme disease transmission around the home in endemic
de has to be reapplied on a regular basis and many communities
about such repeated applications, so this method of control
cks by keeping grass and brush trimmed
Is there a vaccination available to
prevent Lyme disease?
ccine currently available for Lyme disease. LYMErix, once available as
yme disease, was removed from the market in February, 2002
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