What should be done if a Borrelia test is positive? - briefly
Confirm the result with a second, more specific assay (e.g., Western blot or PCR) and initiate guideline‑based antibiotic treatment promptly. Arrange follow‑up assessment to verify symptom resolution and monitor for adverse reactions.
What should be done if a Borrelia test is positive? - in detail
A positive Borrelia assay requires immediate verification and clinical correlation. First, confirm the result with a second-tier test, typically a Western blot, to reduce false‑positive rates. If the confirmatory test is also positive, assess the patient’s symptoms and exposure history to determine disease stage (early localized, early disseminated, or late).
Based on the stage, initiate an appropriate antimicrobial regimen:
- Early localized disease – oral doxycycline 100 mg twice daily for 10–14 days; amoxicillin or cefuroxime are alternatives for contraindications.
- Early disseminated disease – oral doxycycline for 14–21 days, or intravenous ceftriaxone 2 g daily for 14–28 days if neurological or cardiac involvement is present.
- Late disseminated disease – intravenous ceftriaxone for 28 days, followed by oral doxycycline for an additional 14 days if needed.
Document the treatment plan, including drug choice, dosage, and duration. Educate the patient on potential side effects, the importance of adherence, and signs of worsening disease.
Schedule follow‑up visits at 2‑4 weeks and again at 3‑6 months to:
- Evaluate symptom resolution.
- Perform repeat serology only if the clinical picture changes; serologic titers often remain elevated despite successful therapy.
- Adjust therapy if new manifestations appear or if the patient fails to improve.
Consider referral to an infectious‑disease specialist when:
- Neurologic, cardiac, or arthritic complications develop.
- The patient presents with atypical features or co‑infection risk (e.g., Anaplasma, Babesia).
- There is uncertainty about the interpretation of serologic results.
Maintain a detailed record of all laboratory data, medication courses, and patient-reported outcomes to support ongoing care and potential epidemiologic reporting.