How to treat borreliosis from a tick? - briefly
The standard regimen is doxycycline 100 mg orally twice daily for 10–21 days, started promptly after diagnosis. If doxycycline is unsuitable, amoxicillin or cefuroxime may be used as alternatives.
How to treat borreliosis from a tick? - in detail
Tick‑borne borreliosis requires prompt antimicrobial therapy to prevent dissemination and chronic manifestations. The standard regimen for early localized infection consists of oral doxycycline 100 mg twice daily for 10–14 days. Doxycycline is preferred because it achieves adequate tissue concentrations and covers possible co‑infecting agents such as Anaplasma. For patients unable to tolerate doxycycline, amoxicillin 500 mg three times daily or cefuroxime axetil 500 mg twice daily for the same duration are acceptable alternatives.
When neurological involvement (meningitis, radiculopathy, cranial neuropathy) is documented, intravenous ceftriaxone 2 g daily for 14–28 days is recommended. In cases of cardiac involvement (Lyme myocarditis, atrioventricular block), the same intravenous ceftriaxone protocol applies, often followed by an oral course to complete 21–28 days total therapy. For pregnant or breastfeeding individuals, oral amoxicillin remains the drug of choice; doxycycline is contraindicated.
Late disseminated disease presenting with arthritis or persistent skin lesions warrants oral doxycycline for 28 days or, alternatively, a 28‑day course of cefuroxime or amoxicillin. If arthritis persists beyond three months despite adequate antibiotic exposure, intra‑articular corticosteroid injection may be considered after confirming sterile joint fluid.
Monitoring includes:
- Baseline and follow‑up serology (ELISA, Western blot) to verify seroconversion, not to assess treatment success.
- Clinical assessment of symptom resolution at 2‑week, 4‑week, and 3‑month intervals.
- Laboratory evaluation of inflammatory markers (CRP, ESR) for severe systemic disease.
- ECG monitoring for cardiac involvement during the acute phase.
Adverse‑event management:
- Gastrointestinal upset from doxycycline mitigated by taking the drug with food and adequate hydration.
- Photosensitivity precautions for doxycycline users.
- Renal function assessment before ceftriaxone administration; dose adjustment required for severe impairment.
Patients with persistent symptoms after standard therapy, often termed post‑treatment Lyme disease syndrome, should undergo thorough evaluation for alternative diagnoses. Extended antibiotic courses lack evidence of benefit and carry significant risk; supportive care and symptom‑directed therapy are advised.
Prevention measures—prompt tick removal, use of repellents, and regular body checks—reduce infection risk, but once transmission occurs, adherence to the outlined antimicrobial protocols determines clinical outcome.