Antibiotics for Lyme Disease
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How It Works
These drugs kill Borrelia burgdorferi bacteria, which cause Lyme disease.
Why It Is Used
Antibiotics are used to cure early Lyme disease and to greatly reduce the risk of future complications. Antibiotics may also be used in the later stages of Lyme disease, when additional symptoms involving the skin, joints, nervous system, or heart may develop.
The type of antibiotic prescribed depends on your age, symptoms, any antibiotic allergies you may have, and the stage of Lyme disease. These medicines may be taken orally, as an injection, or through a vein (intravenous, or IV). The length of antibiotic treatment varies according to how bad the disease and your symptoms are, but treatment generally lasts less than 4 weeks.
Early Lyme disease
- For people ages 8 and older, the number of days the antibiotic is used depends on the antibiotic and the severity of the infection.
- Doxycycline should not be used to treat pregnant women or children younger than age 8.
- For children younger than age 8, amoxicillin is taken by mouth. Other medicines may be used if the child is allergic to amoxicillin.
Later stages of Lyme disease
- For Lyme arthritis, oral antibiotics are usually taken for several weeks. If treatment with the oral antibiotic is not successful, an antibiotic may be given intravenously (IV).
- For facial paralysis with no other nervous system problems, an oral antibiotic for several weeks is usually effective.
- For severe heart symptoms of Lyme disease or for other Lyme disease nervous system problems such as Lyme meningitis, IV antibiotics may be given.
Pregnant or nursing women
- Women who have early Lyme disease usually take an oral antibiotic for several weeks. Some doctors believe that pregnant women with early Lyme disease should receive IV antibiotics to prevent Lyme disease bacteria from crossing the protective membrane (placenta) that surrounds the developing fetus. But there is no proof such treatment is needed.
- In pregnant or nursing women who have late Lyme disease, IV antibiotics usually are used.
How Well It Works
Early treatment with antibiotics can cure the Lyme disease infection and help prevent future problems with arthritis, the heart, or the nervous system.1 But symptoms may not go away right away. Some symptoms may last for several weeks after treatment. This does not mean that the antibiotics were not successful, nor does it mean that you need additional antibiotic treatment.
Antibiotic treatment for early symptoms of chronic Lyme arthritis is usually very effective. Joints that have been badly damaged by Lyme arthritis may take a long time to get better after the infection has been cured, or they may not respond to treatment at all. A small percentage of people in the United States continue to have symptoms of chronic Lyme arthritis after treatment with antibiotics.2
Heart symptoms often begin to go away before antibiotics are given. If not, they usually respond to antibiotic therapy within days. Mild heart symptoms that may occur with early Lyme disease usually improve after treatment with oral amoxicillin or doxycycline for 21 to 30 days.
Symptoms of inflammation of the membrane surrounding the brain and spinal cord (Lyme meningitis) begin to improve by the second day of therapy and usually disappear after 7 to 10 days.
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call 911 or other emergency services right away if you have:
- Trouble breathing.
- Swelling of your face, lips, tongue, or throat.
Call your doctor if you:
- Develop hives.
- Have severe diarrhea.
- Still feel very sick more than 24 hours after starting antibiotics. During the first 24 hours of antibiotic therapy, you may have a higher fever, redder rash, or greater pain. This is not an allergic reaction to the medicine. It may mean that the bacteria are rapidly dying.
Common side effects of these medicines include:
- Nausea or upset stomach.
- Mild diarrhea.
- Bad taste in the mouth.
- Vaginal yeast infection.
Some people treated for early Lyme disease have headaches, muscle and joint pain, and tiredness that may continue for a while after treatment. These symptoms usually go away on their own within 6 months and do not require more treatment.
One large study suggests that people who take erythromycin along with certain common medicines may raise their risk of sudden cardiac death.3 The study showed that the risk of dying from a heart problem is greater when erythromycin is taken with some medicines—such as certain calcium channel blockers, certain antifungal medicines, and some antidepressants—than when these medicines are not taken together.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Doxycycline should be taken with plenty of fluids and not while you are lying down or right before bedtime.
Doxycycline is the drug of choice for treating early Lyme disease in people ages 8 and older. But it should not be given to pregnant women or to people who are allergic to tetracycline.
If you get intravenous (IV) antibiotics, you may have weekly blood tests to check your white blood cell count. The IV antibiotic treatment may lead to low levels of white blood cells (called leukopenia) that can make it hard for you to fight infection.
With the exception of pregnant women and people with severe arthritis or heart problems, most people who have been exposed to ticks but do not have symptoms are not given antibiotics. Even in parts of the country where Lyme disease is known to occur often, the risk of getting Lyme disease is too small to warrant treatment before symptoms appear.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
- Weinstein A (2011). Lyme disease. In ET Bope et al., eds., Conn's Current Therapy 2012, pp. 138–141. Philadelphia: Elsevier Saunders.
- Steere AC (2010). Borrelia burgdorferi (Lyme Disease, Lyme Borreliosis). In GL Mandell et al., eds., Principles and Practices of Infectious Diseases, 7th ed., chap. 239, pp. 3071–3081. Philadelphia: Elsevier Churchill Livingstone.
- Ray WA, et al. (2004). Oral erythromycin and the risk of sudden death from cardiac causes. New England Journal of Medicine, 351(11): 1089–1096.
Last Revised: February 6, 2013
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