How should I treat Lyme disease transmitted by ticks? - briefly
Treat Lyme disease promptly with a prescribed antibiotic regimen, typically doxycycline for 10–21 days (or amoxicillin/cefuroxime for those unable to take doxycycline). Early therapy reduces the risk of persistent symptoms and serious complications.
How should I treat Lyme disease transmitted by ticks? - in detail
Tick-borne Lyme disease requires prompt antimicrobial therapy to prevent disseminated infection and long‑term sequelae. Initial evaluation should confirm exposure history, the presence of an erythema migrans rash, or supportive laboratory evidence (two‑tier serology). Empiric treatment begins as soon as clinical suspicion is high, without waiting for test results.
First‑line antibiotics
- Doxycycline 100 mg orally twice daily for 10–21 days (adult, adolescent); contraindicated in pregnancy and children under 8 years.
- Amoxicillin 500 mg orally three times daily for 14–21 days (pregnant, lactating, or pediatric patients).
- Cefuroxime axetil 500 mg orally twice daily for 14–21 days (alternative when doxycycline is unsuitable).
Alternative regimens for patients unable to tolerate oral agents or with severe manifestations (e.g., meningitis, carditis, arthritis) include:
- Intravenous ceftriaxone 2 g daily for 14–28 days.
- Intravenous penicillin G 18–24 million units per day, divided every 4 hours, for 14–28 days.
Monitoring and follow‑up
- Reassess symptoms at the end of therapy; persistent joint swelling may warrant a 4‑week course of oral doxycycline.
- Serologic titers are not useful for evaluating treatment response; clinical improvement guides management.
- Document adverse reactions; common side effects include gastrointestinal upset (doxycycline), photosensitivity, and, rarely, Clostridioides difficile infection (broad‑spectrum agents).
Special populations
- Pregnant or lactating women: amoxicillin or cefuroxime are preferred; avoid doxycycline.
- Children ≤8 years: amoxicillin is the standard; cefuroxime may be used if necessary.
- Immunocompromised patients: consider extended IV therapy and close clinical monitoring.
Adjunctive care
- Anti‑inflammatory agents (e.g., ibuprofen) for arthritic pain, provided no contraindications.
- Physical therapy for persistent joint stiffness after infection resolution.
- Education on tick avoidance, prompt removal, and proper clothing to reduce reinfection risk.
Timely initiation of the appropriate antibiotic regimen, adherence to the prescribed duration, and vigilant follow‑up constitute the core strategy for managing Lyme disease transmitted by ticks.