Patient information: Lyme disease treatment

LYME DISEASE OVERVIEW

Lyme disease is the most common tick-borne illness in the United States and Europe. Lyme disease is caused by an infection with the bacteria, Borrelia burgdorferi, which are carried by deer ticks. The bacteria are transmitted when a tick bites.

In most people, treatment with antibiotics is very effective at eliminating symptoms, preventing complications of the disease, and curing the infection. Some symptoms improve rapidly with this treatment, whereas other symptoms gradually improve over weeks to months.

This topic review discusses the treatment and prevention of Lyme disease. Separate topic reviews discuss what to do after a tick bite to prevent Lyme disease and the symptoms and diagnosis of Lyme disease. (See "Patient information: What to do after a tick bite" and "Patient information: Lyme disease symptoms and diagnosis" and "Patient information: Lyme disease prevention".)

More detailed information about Lyme disease is available by subscription. (See "Clinical manifestations of Lyme disease in adults" and "Diagnosis of Lyme disease" and "Evaluation of a tick bite for possible Lyme disease" and "Treatment of Lyme disease".)

LYME DISEASE TREATMENT

Antibiotics are the primary treatment for Lyme disease, and almost all patients recover after antibiotic treatment. However, recovery may take weeks to months after finishing antibiotic treatment.

However, people who recover slowly do NOT benefit from taking additional antibiotics. There is no evidence that the Lyme bacteria is resistant to any of the antibiotics commonly used to treat the infection. (See "Treatment of Lyme disease".)

In about 10 to 15 percent of individuals with early Lyme disease, substances released by the dying bacteria cause a brief worsening of symptoms (called a Jarisch-Herxheimer reaction). This reaction occurs within 24 hours after starting antibiotics, continues for a day or so, and then resolves. Antibiotic therapy should not be stopped if this reaction develops, but should instead continue as originally planned.

Early localized Lyme disease — Early localized Lyme disease (the erythema migrans rash, with or without flu-like symptoms) is treated with oral antibiotics, usually doxycycline, amoxicillin, or cefuroxime, taken daily for 10 to 21 days.

Individuals with one or more EM lesion(s) who also have joint pain should be treated with oral antibiotics. Antibiotics prevent worsening of the disease and may decrease the duration and severity of symptoms. (See "Musculoskeletal manifestations of Lyme disease".)

Early disseminated Lyme disease — Most cases of Lyme disease that cause neurologic or cardiac features are treated with intravenous antibiotics, usually ceftriaxone or cefotaxime. These antibiotics are administered daily for two to four weeks through an intravenous line.

Intravenous (IV) therapy is usually started in a healthcare provider's office or emergency department. It can be continued at home and monitored by a visiting or home health nurse. Patients receiving home intravenous therapy should watch for symptoms of infection or inflammation at the site of the IV line (pain, redness, and swelling) and symptoms of blood clots in the vein (pain and swelling in the arm or armpit).

• Heart block — Intravenous antibiotics are usually recommended for the treatment of serious heart block caused by Lyme disease, although the mildest forms may be treated with oral antibiotics and close monitoring. A patient with heart block may be hospitalized to monitor the severity of the condition and to determine if any other cardiac problems are present. In addition to antibiotic therapy, individuals with heart block may require a temporary pacemaker. (See "Lyme carditis".)

In most individuals, heart block is temporary and may improve even before antibiotics are started. Heart block resolves in most people with Lyme disease within several weeks.

• Facial palsy — A lumbar puncture is often recommended for individuals whose only symptom is facial muscle weakness caused by facial nerve palsy. If the blood tests are positive for Lyme disease but the cerebrospinal fluid (CSF) tests are normal, oral doxycycline should be given; if the CSF results are suggestive of Lyme disease, intravenous antibiotics are usually given. Facial weakness usually resolves after treatment. (See "Musculoskeletal manifestations of Lyme disease".)

• Meningitis — Although meningitis typically resolves on its own, intravenous antibiotic therapy, usually with ceftriaxone or cefotaxime, given daily for two to four weeks, is recommended to speed resolution of symptoms and prevent later complications of Lyme disease.

Late Lyme disease — Certain types of late Lyme disease are treated with intravenous antibiotics.

• Arthritis — In most individuals, the arthritis of late Lyme disease resolves with oral antibiotic therapy given for 28 days; intravenous antibiotics are recommended only if the arthritis does not improve with oral treatment. However, in some adults and children, arthritis persists after antibiotic therapy.

Arthritis that lingers after antibiotic therapy may require therapies used for other types of arthritis, such as hydroxychloroquine and/or synovectomy (surgical removal of the joint lining). (See "Patient information: Osteoarthritis treatment", for more information about these treatments").

• Neurologic conditions — Neurologic conditions associated with late Lyme disease are treated with intravenous antibiotics, usually ceftriaxone or cefotaxime, given daily for two to four weeks.

Post-Lyme disease syndrome — In some people, symptoms such as headache, fatigue, and joint pain do not resolve immediately after treatment is completed. These symptoms usually resolve gradually over time. Taking more antibiotics does not improve symptoms or shorten the course of post-Lyme symptoms.

Chronic Lyme disease — Chronic Lyme disease is a term that is used to describe symptoms of pain, fatigue, and difficulty thinking clearly that occur after antibiotic treatment of Lyme disease. There is no evidence that people with these symptoms still have active infection. If you have symptoms that do not resolve after appropriate antibiotic therapy, you may have been incorrectly diagnosed with Lyme disease.

CAN I GET LYME DISEASE AGAIN?

After being infected with and treated for early Lyme disease, it is possible to become infected with Lyme disease again. However, there has never been a case of re-infection with Lyme disease in a person who has had late Lyme disease.

IS LYME DISEASE TREATMENT NECESSARY AFTER A TICK BITE?

Several factors must be taken into consideration when deciding if antibiotic treatment is necessary after a tick bite to prevent Lyme disease. (See "Patient information: What to do after a tick bite" and "Evaluation of a tick bite for possible Lyme disease".)

PREVENTING LYME DISEASE

You can take steps to prevent infection with Lyme disease. This is discussed in a separate article. (See "Patient information: Lyme disease prevention".)

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem. Because no two people are exactly alike and recommendations can vary from one person to another, it is important to seek guidance from a provider who is familiar with your individual situation.

This discussion will be updated as needed every four months on our web site (www.uptodate.com/patients). Additional topics as well as selected discussions written for healthcare professionals are also available for those who would like more detailed information.

Some of the most pertinent include:

Patient Level Information:
Patient information: What to do after a tick bite
Patient information: Lyme disease symptoms and diagnosis
Patient information: Lyme disease prevention
Patient information: Osteoarthritis treatment

Professional Level Information:
Clinical manifestations of Lyme disease in adults
Diagnosis of Lyme disease
Evaluation of a tick bite for possible Lyme disease
Lyme carditis
Microbiology and epidemiology of Lyme disease
Musculoskeletal manifestations of Lyme disease
Prevention of Lyme disease
Treatment of Lyme disease

A number of web sites have information about medical problems and treatments, although it can be difficult to know which sites are reputable. Information provided by the National Institutes of Health, national medical societies and some other well-established organizations are often reliable sources of information, although the frequency with which they are updated is variable.

• National Library of Medicine

      (www.nlm.nih.gov/medlineplus/lymedisease.html, available in Spanish)

• National Institute of Allergy and Infectious Diseases

      (www3.niaid.nih.gov/topics/lymeDisease/)

• A review of Chronic Lyme Disease

      (www3.niaid.nih.gov/topics/lymeDisease/understanding/chronic.htm)

• Center for Disease Control and Prevention

      (www.cdc.gov/ncidod/dvbid/lyme/)

• American Lyme Disease Foundation, Inc.

      (www.aldf.com/faq.shtml, available in Spanish)

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