Treatment
Treatment
Options
This list is here only to show as a sample, what a typical
treatment plan may be by your treating physician. It is in no
way meant to be a suggestive treatment plan by Dr. Murakami.
Your physician will advise as to what the treatment plan for
you will be.
Presumptive
Patient Group
Tx Line
Treatment
known tick bite
1st
-single-dose antibiotic
prophylaxis
1. An engorged tick is removed
after at least an estimated 36 hours of attachment.
2. Prophylaxis is started within
72 hours of tick removal.
3. B
burgdorferi prevalence in local ticks is known to
be greater than 20%.
4. Doxycycline is not
contraindicated (contraindications include children <8
years of age, pregnancy or lactation).
Primary Options
Acute
Patient Group
Tx
Line Treatment
erythema
migrans 1st
-oral antibiotic therapy
- Oral antibiotics are recommended for patients with Lyme
disease (local or disseminated) with erythema migrans, in
the absence of cardiovascular or neurologic manifestations.
- Doxycycline is contraindicated in children <8 years
of age, and during pregnancy and lactation. Amoxicillin and
cefuroxime may be used safely in these patients.
- Macrolides (e.g., azithromycin or erythromycin) are not
recommended as first-line treatment. They should be reserved
for patients with intolerance or allergy to first-line
agents, with close monitoring for resolution of symptoms.
- First-generation cephalosporins are ineffective for the
treatment of Lyme disease.
- Various studies have used 10 to 21 days of treatment,
but these have not been compared head to head. In most cases
14 days is adequate, but there is not complete consensus.
However, azithromycin is only given for 7 to 10
days.
Primary Options
Secondary Options
Patient Group
Tx
Line
Treatment
erythema
migrans
1st
-oral antibiotic therapy
indistinguishable
from
community-acquired
cellulitis
- When erythema migrans cannot be distinguished from
community-acquired cellulitis, cefuroxime or
amoxicillin/clavulanate is recommended.
- Various studies have used 10 to 21 days of treatment,
but these have not been compared head to head. In most cases
14 days is adequate, but there is not complete
consensus.
Primary Options
- amoxicillin/clavulanate : oral
Patient Group
Tx
Line
Treatment
cardiac
complications 1st
-oral antibiotic therapy
without high-grade
heart block
- Oral antibiotic therapy is recommended for patients with
cardiac complications but without any of the following:
chest pain, syncope, dyspnea, second- or third-degree AV
block, or first-degree block with PR interval ?300
milliseconds. [1] [36] Patients with any of these preceding
features are treated with parenteral antibiotic
therapy.
- Various studies have used 10 to 21 days of treatment,
but these have not been compared head to head. In most cases
14 days is adequate, but there is not complete
consensus.
Primary
Options
Patient Group
Tx
Line Treatment
neurologic
complications 1st
- intravenous antibiotic therapy
or high-grade heart
block
- Intravenous antibiotics are used for Lyme disease with
neurologic complications (e.g., meningitis, radiculitis,
encephalitis) or cardiac complications involving high-grade
heart block.
- Hospitalization and continuous monitoring are required
for patients with chest pain, syncope, dyspnea, second- or
third-degree AV block, or first-degree block with PR
interval ?300 milliseconds.
- Ceftriaxone is the drug of choice for both adults and
children.
- Alternative agents include cefotaxime or penicillin-G
for patients with neurologic or cardiac complications of
Lyme disease and normal renal function.
- Doxycycline is an alternative agent for patients with
neurologic or cardiac complications who are intolerant of
penicillins or cephalosporins; however, it should be avoided
in children <8 years of age and pregnancy or
lactation.
- Various studies have used 10 to 28 days of treatment. In
most cases 14 days is adequate, but there is not complete
consensus.
Primary
Options
Secondary
Options
- penicillin G potassium aqueous : IV
Tertiary
Options
adjunct
-temporary pacemaker
- Temporary pacemaker is recommended for patients with
advanced AV block. [1] [36]
Patient Group
Tx
Line
Treatment
arthritis 1st
-oral antibiotic therapy
- Lyme arthritis can be treated with the same preferred
oral regimens as for uncomplicated Lyme disease, for an
extended period of treatment (28 days total).
- Persistence or recurrence of symptoms will require
retreatment.
Primary Options
Secondary Options
adjunct -nonsteroidal
anti-inflammatory
drugs
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can be
used for symptom relief for Lyme arthritis, along with
antibiotic therapy.
Primary Options
Ongoing
Patient Group
Tx Line
Treatment
recurrent or
1st
-oral or intravenous antibiotic therapy
persistent
arthritis
- Persistence or recurrence of arthritis symptoms should
be retreated with a second 4-week course of oral antibiotics
or a 2- to 4-week course of intravenous ceftriaxone. [1]
[38] [39]
- Oral treatment is preferable, unless there was no
response to oral therapy at all in the first cycle.
Primary Options
Secondary Options
antibiotic-refractory
arthritis 1st
-arthroscopic
synovectomy or
pharmacotherapy
- Arthroscopic synovectomy has been used successfully in
patients with antibiotic-refractory Lyme arthritis.
- Anecdotal use of intraarticular injections of
corticosteroids, systemic administration of nonsteroidal
anti-inflammatory drugs (NSAIDs), or disease-modifying
antirheumatic drugs (DMARDs) such as hydroxychloroquine have
also been reported to help patients with
antibiotic-refractory Lyme arthritis.
These treatments should only be
initiated under specialist supervision.
Reference1
Wormser GP, Dattwyler RJ, Shapiro ED, et
al. The clinical assessment, treatment, and prevention of Lyme
disease, human granulocytic anaplasmosis, and babesiosis:
clinical practice guidelines by the Infectious Diseases
Society of America. Clin Infect Dis.
2006;43:1089-1134.[Abstract] http://www.ncbi.nlm.nih.gov/pubmed/17029130[Full Text] http://www.journals.uchicago.edu/doi/full/10.1086/508667
Reference13
Hayes EB, Piesman J. How can we prevent
Lyme disease? N Engl J Med. 2003;348:2424-2430.[Abstract]
http://www.ncbi.nlm.nih.gov/pubmed/12802029
Reference14
Lathrop SL, Ball R, Haber P, et al.
Adverse event reports following vaccination for Lyme disease:
December 1998-July 2000. Vaccine. 2002;20:1603-1608.[Abstract]
http://www.ncbi.nlm.nih.gov/pubmed/11858868
Reference15
Nadelman RB, Nowakowski J, Fish D, et al.
Prophylaxis with single-dose doxycycline for the prevention of
Lyme disease after an Ixodes scapularis tick bite. N Engl J
Med. 2001;345:79-84.[Abstract] http://www.ncbi.nlm.nih.gov/pubmed/11450675
Reference36
Sigal LH. Early disseminated Lyme
disease: cardiac manifestations. Am J Med. 1995;98:25S-28S.
[Abstract] http://www.ncbi.nlm.nih.gov/pubmed/7726189
Reference38
Steere AC, Levin RE, Molloy PJ, et al.
Treatment of Lyme arthritis. Arthritis Rheum.
1994;37:878-888.[Abstract] http://www.ncbi.nlm.nih.gov/pubmed/8003060
Reference39
Eckman MH, Steere AC, Kalish RA, et al.
Cost effectiveness of oral as compared with intravenous
antibiotic treatment for patients with early Lyme disease or
Lyme arthritis. N Engl J Med. 1997;337:357-363.[Abstract]
http://www.ncbi.nlm.nih.gov/pubmed/9233874