How to treat Lyme disease from a tick? - briefly
A 2‑ to 4‑week course of doxycycline (or amoxicillin/cefuroxime if doxycycline is contraindicated) is the standard first‑line therapy, started promptly after diagnosis. Follow‑up involves monitoring symptom resolution and addressing any persistent manifestations.
How to treat Lyme disease from a tick? - in detail
Lyme disease, caused by the bacterium Borrelia burgdorferi transmitted through tick bites, requires prompt antimicrobial therapy to prevent progression and chronic complications.
The therapeutic approach depends on disease stage, clinical presentation, and patient characteristics.
Early localized infection (characterized by erythema migrans or flu‑like symptoms within 30 days of exposure):
- Oral doxycycline 100 mg twice daily for 10–21 days (preferred for adults and children ≥8 years).
- Alternative regimens: amoxicillin 500 mg three times daily for 14–21 days, or cefuroxime axetil 500 mg twice daily for 14–21 days.
- Doxycycline also provides coverage for co‑infection with Anaplasma or Babesia when indicated.
Early disseminated infection (multiple erythema migrans lesions, neurologic involvement, cardiac manifestations, or arthritis within weeks to months):
- Oral doxycycline 100 mg twice daily for 21–28 days remains first‑line for most manifestations.
- Intravenous ceftriaxone 2 g once daily for 14–28 days is recommended for severe neurologic disease (e.g., meningitis, cranial nerve palsy) or Lyme carditis with high‑degree atrioventricular block.
- For patients unable to receive doxycycline (pregnancy, severe allergy), intravenous ceftriaxone or oral amoxicillin may be used, adjusting duration to 28 days.
Late disseminated disease (arthritis, chronic neurologic deficits after months):
- Oral doxycycline 100 mg twice daily for 28 days is standard.
- Intravenous ceftriaxone for 28 days may be indicated for refractory neurologic disease.
- In cases of persistent arthritis, a short course of oral steroids may be added after 4 weeks of antibiotics, but only under specialist supervision.
Supportive measures:
- Anti‑inflammatory agents (e.g., NSAIDs) for joint pain.
- Physical therapy for musculoskeletal symptoms.
- Monitoring of cardiac rhythm in patients with suspected carditis; temporary pacing may be required for high‑grade block.
Follow‑up:
- Re‑evaluate at 2–4 weeks after therapy completion to assess symptom resolution.
- Persistent or recurrent symptoms warrant repeat serologic testing, imaging, or referral to an infectious‑disease specialist.
Special populations:
- Pregnant or lactating women: oral amoxicillin 500 mg three times daily for 14–21 days; avoid doxycycline and ceftriaxone unless benefits outweigh risks.
- Children <8 years: amoxicillin or cefuroxime as first‑line; doxycycline reserved for older children.
Adherence to the full antibiotic course, early recognition of disease stage, and appropriate selection of agents are essential to achieve cure and minimize long‑term sequelae.