Treating Lyme Disease

Nearly all Lyme disease patients can be effectively treated with an appropriate course of antibiotic therapy. In general, the sooner such therapy is begun following infection, the quicker and more complete the recovery.

Antibiotics such as doxycycline or amoxicillin taken orally for an average of two weeks can speed the healing of the erythema migrans rash and usually prevent subsequent symptoms such as arthritis or neurological problems. There is no compelling evidence that prolonged antibiotic therapy is more effective than two weeks of therapy. Unnecessarily prolonged antibiotic use might have serious side effects, such as upset stomach, diarrhea, and Clostridium difficile infection.

Patients younger than 9 years old, or pregnant or lactating women with Lyme disease, are treated with amoxicillin or penicillin because doxycycline can stain the permanent teeth developing in young children or unborn babies. Patients allergic to penicillin are given erythromycin or related antibiotics.

People with Lyme disease who have neurological symptoms might be treated with an antibiotic given intravenously for a month or less. Most patients experience full recovery.

Lyme arthritis resolves in most patients within a few weeks or months following antibiotic therapy. Some Lyme disease patients who are untreated for several years might be cured of their arthritis with the proper antibiotic regimen. Oral antibiotics are usually effective, and intravenous antibiotics are only rarely needed.

Doctors prefer to treat Lyme disease patients experiencing heart symptoms with antibiotics such as ceftriaxone, cefotaxime, or penicillin given intravenously for about two weeks. If these symptoms persist or are severe enough, patients might also be given temporary internal cardiac pacemakers. People with Lyme disease rarely experience long-term heart damage.

A very small percentage of patients with Lyme disease may have residual symptoms that may be prolonged after treatment with antibiotics. These symptoms can include muscle and joint pains, arthritis, cognitive defects, sleep disturbance, or fatigue. Although the cause of these prolonged symptoms is unknown, there is some evidence that they result from an autoimmune response in which the immune system continues to respond to an infection even after it was been eliminated from the body, although this is an area of debate.

Successful treatment of Lyme disease is no guarantee that the illness will be prevented in the future. The disease can strike more than once in the same individual if he or she is bitten by another tick and reinfected with the Lyme disease bacterium.