Treatment of Lyme Disease

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Early infection, either local or disseminated, should be treated with doxycycline or amoxicillin—or an alternative—for 14–21 days. Treatment relieves early symptoms and promotes resolution of skin lesions. Doxycycline may be more effective than amoxicillin in preventing late manifestations. Established arthritis may respond to prolonged therapy with doxycycline or amoxicillin orally or penicillin G or ceftriaxone intravenously. In refractory cases, ceftriaxone has been effective. Nearly 50% of patients treated with doxycycline or amoxicillin early in the course of Lyme disease develop minor late complications (headache, joint pains, etc). Patients with certain neurological or cardiac forms of illness may require intravenous treatment with drugs such as ceftriaxone or penicillin.
Approximately 10 to 20% of patients treated for Lyme disease with a recommended 2–4 week course of antibiotics will have lingering symptoms of fatigue, pain, or joint and muscle aches. In some cases, these can last for more than 6 months. Although often called "chronic Lyme disease," this condition is properly known as "Post-treatment Lyme Disease Syndrome" (PTLDS).
Prevention is based on avoidance of exposure to ticks. Long sleeves and long pants tucked into socks are recommended. Careful examination of the skin for ticks after being outdoors can locate ticks for removal before they transmit B burgdorferi.
Embers ME, Barthold SW, Borda JT, Bowers L, Doyle L, et al. (2012) Persistence of Borrelia burgdorferi in Rhesus macaques following antibiotic treatment of disseminated infection. PLoS ONE 7(1): e29914
Morse SA, Brooks GF, Carroll KC, Butel JS, Mietzner TA. Chapter 24. Spirochetes & Other Spiral Microorganisms. In: Morse SA, Brooks GF, Carroll KC, Butel JS, Mietzner TA, eds. Jawetz, Melnick…...