How to treat Lyme disease transmitted by ticks? - briefly
Administer a 2–4‑week oral course of doxycycline (or amoxicillin/cefuroxime if contraindicated) as first‑line therapy, and use intravenous ceftriaxone for severe or late manifestations.
How to treat Lyme disease transmitted by ticks? - in detail
Tick‑borne Lyme disease requires prompt antimicrobial therapy to prevent progression and complications. The choice of drug, dosage, and treatment length depend on the stage of infection, patient age, and presence of specific manifestations such as meningitis, arthritis, or cardiac involvement.
Early localized infection (characterized by erythema migrans or flu‑like symptoms) is treated with oral doxycycline 100 mg twice daily for 10–14 days in adults and children ≥8 years. For patients unable to receive doxycycline (e.g., pregnancy, severe allergy), amoxicillin 500 mg three times daily or cefuroxime axetil 500 mg twice daily for the same duration are appropriate alternatives.
Early disseminated disease (multiple skin lesions, neurologic signs, or cardiac involvement) also responds to oral doxycycline for 14–21 days. When meningitis, severe radiculoneuritis, or high‑grade atrioventricular block occurs, intravenous ceftriaxone 2 g daily (or cefotaxime 2 g every 6 hours) for 14–28 days is recommended. Pediatric dosing follows weight‑based guidelines (e.g., ceftriaxone 50 mg/kg once daily).
Late manifestations such as persistent arthritis or chronic neurologic symptoms require extended oral therapy. Doxycycline 100 mg twice daily for 28 days, or amoxicillin 500 mg three times daily for the same period, is standard. In refractory arthritis, a second course of oral antibiotics may be considered, followed by intra‑articular corticosteroid injection if inflammation persists.
Adjunctive measures include analgesics for joint pain, anti‑inflammatory agents such as NSAIDs, and physical therapy to maintain joint mobility. Patients with cardiac involvement should receive cardiac monitoring and, if necessary, temporary pacing.
Follow‑up involves clinical reassessment at the end of therapy and, when indicated, serologic testing to confirm declining antibody titers. Persistent symptoms after adequate treatment merit evaluation for co‑infection (e.g., Babesia, Anaplasma) and consideration of post‑treatment Lyme disease syndrome, which may require symptom‑targeted management.
Special populations: Pregnant or lactating women receive amoxicillin 500 mg three times daily for 14–21 days. Children <8 years receive amoxicillin or cefuroxime at weight‑adjusted doses; doxycycline is avoided due to dental toxicity risk.
Effective management hinges on early diagnosis, appropriate antimicrobial selection, and adherence to the prescribed course. Delayed or incomplete treatment increases the risk of chronic joint, neurologic, or cardiac complications.