Treatment of Lyme Disease with Antibiotics

Lyme disease is a multi system inflammatory disease caused by organism Borrelia, which is spread by the bite of infected tick called Ixodes scapularis. Lyme disease is mostly seen in the Northeastern and Midwestern United States and along the Pacific coast. Prompt diagnosis should be followed by treatment with various antibiotics that can be used to take care of this disease. The treatment of Lyme disease is dependent on the clinical manifestations of the disease.

Step 1

Treat early localized Lyme disease with one of the following antibiotics for 10 to 21 days: doxycycline, amoxicillin or cefuroxime axetil.

Step 2

Treat early disseminated and late Lyme disease (especially late Lyme neurological disease) with Intravenous antibiotic therapy with third generation cephalosporins such as ceftriaxone or cefotaxime or penicillin G in for two to four weeks.

Step 3

Give doxycycline to adults and children who are intolerant of above antibiotics

Step 4

Prescribe oral therapy with doxycycline, amoxicillin, or cefuroxime axetil for 28 day in late Lyme disease with arthritis.

Tips & Warnings:

There is no proven role for a number of other intravenous antibiotics, such as imipenem-cilastatin, ceftazidime, cefuroxime, vancomycin and ampicillin. The use of any of these antibiotics should be avoided for the risk of community-based resistance to these agents. Doxycycline is not recommended for children under the age of 8 years or for pregnant or lactating women.

Treatment duration of Lymes Disease:

Do not treat for more than four weeks as it is not beneficial.

====================================================================================

(I am adding this refrence text from Uptodate Online after reading the response from various readers. This should clarify the confusion about the long-term antibiotic therapy in Lyme's disease)

POST-LYME DISEASE SYNDROME AND CHRONIC LYME DISEASE - Treatment with appropriate antibiotics as defined above is successful in the majority of patients with each of the stages of Lyme disease. The Infectious Diseases Society of America (IDSA) in 2006, the American Academy of Neurology in 2007, and the Ad Hoc International Lyme Disease Group in 2007 concluded that the chronic subjective symptoms that may occur after recommended courses of antibiotic therapy for Lyme disease are not due to persistent infection with B. burgdorferi. There are several reasons for lack of response to standard antibiotic therapy. These include:

1. The initial diagnosis of Lyme disease was incorrect. The frequency with which this might occur in the community was illustrated in a review of 209 patients with a presumptive diagnosis of Lyme disease: only 44 (21 percent) met criteria for active Lyme disease, 40 (19 percent) had prior but not active Lyme disease, and 125 (60 percent) had no evidence of current or prior Lyme disease.
2. Patients with early Lyme disease may be coinfected with another agent transmitted by Ixodes ticks, such as babesiosis or human granulocytic anaplasmosis.
3. It is possible to have both Lyme disease that has been cured and another condition that persists. Examples include fibromyalgia, depression, patellofemoral joint disease, or another clinical entity not related to Lyme disease. Fibromyalgia, in particular, can occur following treatment for Lyme disease.
4. The knee synovitis of Lyme disease may persist for months after antibiotic therapy possibly due to the triggering of an autoimmune process.
5. In patients with previous neurologic involvement, permanent tissue damage may have occurred.

Lack of benefit from additional antibiotics - Post-Lyme disease symptoms are difficult to treat. Randomized controlled trials of repeat antimicrobial therapy in such patients have NOT shown benefit.

Two parallel multicenter controlled trials were performed of prolonged antibiotic therapy in a total of 129 patients with clinical evidence of Lyme disease and persistent subjective symptoms. The symptoms began within six months of the original treatment for acute Lyme disease and lasted for at least six months but less than 12 years by the time of study entry. One trial was conducted in 78 seropositive patients and one in 51 seronegative patients who had clinician observed erythema migrans lesions. Treatment with intravenous ceftriaxone (2 g once daily for 30 days) followed by oral doxycycline (100 mg PO twice daily for 60 days) was compared to treatment with placebo (also identically administered IV then orally).

The two trials were terminated early after an interim analysis in the first 107 patients showed similar outcomes in the two groups. As an example, improvement in physical and mental component scales was seen in 37 percent of seropositive patients receiving antibiotics and 40 percent receiving placebo, no change in 29 and 26 percent, and worsening in 34 percent in both groups.

Another trial included 55 patients with Lyme disease and severe fatigue for at least six months after appropriate antibiotic therapy; the patients were randomly assigned to 28 days of therapy with intravenous ceftriaxone (2 g once daily) or placebo. Treated patients had significant improvement in fatigue compared to those given placebo (26 versus 13 percent, respectively), but there was no difference in cognitive function or a laboratory measure of persistent infection. The authors concluded that intravenous therapy was not indicated for post-Lyme disease fatigue symptoms.

This was also illustrated in a trial in which 37 patients with post-treatment neurocognitive findings and 20 controls were randomly assigned to 10 weeks of intravenous ceftriaxone or placebo. Short-term cognitive improvement was noted at week 12, but was not sustained at week 24 in patients who received ceftriaxone. In addition, 26 percent of those who received ceftriaxone experienced serious adverse effects, most commonly related to the peripherally-inserted central intravenous catheter.

Therefore, Reevaluation, rather than immediate or reflexive re-treatment, is the proper next step in cases of apparent refractory symptoms after a course of appropriate therapy. Further antibiotic therapy for Lyme disease should NOT be given unless there are objective findings of active disease (including physical findings, abnormalities on cerebrospinal or synovial fluid analysis, or changes on formal neuropsychologic testing).

In 2006 and 2007, Infectious Diseases Society of America (IDSA), the American Academy of Neurology (AAN) quality standards subcommittee, and the Ad Hoc International Lyme Disease Group separately reviewed the use of additional antibiotic treatment in patients with persistent symptoms after Lyme disease and concluded that additional or prolonged antibiotic treatment beyond the initial treatment course is not effective and is associated with significant adverse effects. It was recommended that extended courses of antibiotics NOT be given for presumed "chronic" Lyme disease.