Treatment

Antibiotics are the drugs of choice for all phases of Lyme disease. In nearly all cases they can cure Lyme, even in later stages. It should be noted that these recommendations apply only to Lyme disease in the US. The organisms that cause Lyme disease in Europe may require different treatments.

Preventive Antibiotics After a Tick Bite

An expert group has recommended that people bitten by deer ticks should not routinely receive antibiotics to prevent the disease.

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Nevertheless, an important study in 2001 reported that a single 200-mg dose of the antibiotic doxycycline given within 72 hours of the tick bite was effective in preventing disease (87% protection). If 72 hours have passed, simply waiting for symptoms and then treating the disease at that point is very effective and cures nearly all cases..

In general, the risk of developing Lyme disease after being bitten by a tick ranges from only 1 - 3%. The only people who still might need preventive antibiotics are unvaccinated individuals in high-risk areas who have been bitten by ticks that are in the nymph stage and that are at least partially swollen after feeding. (Adult ticks or nymph ticks that are not swollen pose a very low risk.)

Treating Early Stage Lyme Disease

Three to four weeks of either doxycycline or amoxicillin is the standard regimen. The following are treatment guidelines for treating patients who have been bitten by a tick and have symptoms or a reasonably clear diagnosis of early Lyme disease:

• Doxycycline. This antibiotic is effective against both Lyme disease and ehrlichiosis and so is the standard antibiotic for any patient over 8 years old (except pregnant women). It may also be effective for patients with Bell's palsy (although such patients may have other neurologic problems that need more aggressive treatments). Doxycycline cannot be used routinely in children under 8 years old. It is a form of tetracycline and as such discolors teeth and inhibits bone growth. It can also cause birth defects, so it should not be used during pregnancy.
• Either amoxicillin (one of the penicillins) or cefuroxime (Ceftin)--a drug known as a cephalosporin--is the alternative for young children. Amoxicillin is the first choice and also probably the best antibiotic for pregnant women. Unfortunately, many people are allergic to penicillin. In addition, strains of bacteria are emerging that are resistant to penicillins. Either drug is usually given for 20 days. Large studies are needed to determine which drug is more effective in children.
• Erythromycin or similar antibiotics called macrolides are used if none of these drugs are appropriate.
• Intravenous ceftriaxone--another cephalosporin--is usually warranted if there are signs of infection in the central nervous system (the brain or spinal region).

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