There is no single Lyme disease antibiotic as different stages of the condition and the age and circumstances of the patient can affect Lyme disease treatment. However, the majority of patients with either early stage Lyme disease or late stage Lyme disease will receive treatment with doxycycline.Antibiotic treatment prior to diagnosis and the use of long-term antibiotic treatment are advised against in official treatment guidelines as laid out by the Infectious Diseases Society of America (IDSA).
Alternative Lyme disease guidelines for both diagnosis and treatment of Lyme disease have been proposed by the International Lyme and Associated Diseases Society (ILADS) which are generally more aggressive than those given by IDSA but there are concerns over the danger of long-term Lyme disease antibiotic use given the lack of evidence for such treatment.
The following information on Lyme disease antibiotics references the official guidelines as this is the most likely course of treatment a patient with Lyme disease will receive. The usual treatment recommended in early Lyme disease, late stage Lyme disease, neuroborreliosis, and Lyme arthritis are discussed along with the alternatives to doxycycline available for those patients who are pregnant, and for children or those with an intolerance to first-line medications. An overview of the issues around chronic Lyme disease antibiotic treatment is also included.
Lyme Disease Antibiotic in Early Lyme Disease
Patients diagnosed with early stage Lyme disease will usually be prescribed 100mg of the Lyme disease antibiotic doxycycline twice a day for two to three weeks. Amoxicillin may be prescribed instead at a dose of 500mg three times a day. Early disseminated Lyme disease is usually treated in a similar fashion in cases where erythema migrans is observed but there is no neurological involvement or cardiological complication such as third-degree atrioventricular heart block. A common co-infection of Lyme disease, human granulocytic ehrlichiosis (HGE), is another tick-borne vector treatable with doxycycline making this treatment particularly advantageous. Doxycycline does not however treat Babesiosis which may also occur alongside Lyme disease as it is transmitted by ticks.
Lyme Disease and Children – Antibiotic Use
Children under the age of eight are not usually treated with doxycycline, and neither are patients who are pregnant or breastfeeding. The alternative is treatment with cefuroxime axetil which is equally effective but more expensive than doxycycline and, therefore, less commonly prescribed. Children over the age of eight are likely to be prescribed either doxycycline or amoxicillin, with cefuroxime axetil available should it be necessary. In a rare few cases a patient may be unable to take any of these three Lyme disease antibiotics due to allergy or intolerance in which case they are likely to be prescribed macrolide antibiotics.
Erythromycin is an example of a macrolide antibiotic sometimes used to treat Lyme disease although this is not a preferred treatment option as it is less effective than doxycycline, amoxicillin, or cefuroxime axetil. A number of people also suffer side-effects from erythromycin with gastrointestinal symptoms such as nausea fairly common. Patients taking statins are also advised to exert extreme caution with these medications as myelopathy has been associated with this combination of drugs (Sathasivam, et al, 2008).
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