IDSA guideline recommends antimicrobials for Lyme disease

The most recent Lyme disease guideline issued by the Infectious Diseases Society of America recommends the use of antimicrobials to treat most cases of the disease.

For adults with early disseminated Lyme disease associated with erythema migrans and without specific neurologic manifestations, the guideline suggests 100 mg twice-daily doxycycline, 500 mg three-times daily amoxicillin or 500 mg twice-daily cefuroxime axetil, for 14 days duration. For children, the guideline recommends 50 mg/kg daily amoxicillin in three divided doses (500 mg maximum per dose), 30 mg/kg daily cefuroxime axetil in two divided doses (500 mg maximum per dose) or 4 mg/kg daily doxycycline in two divided doses (100 mg maximum per dose) in patients aged 8 years and older.

Among adult patients with late neurologic disease compromising the central or peripheral nervous system, the guideline recommends treatment with IV ceftriaxone for between 2 and 4 weeks. Alternatively, IV cefotaxime is suggested. While treatment response is usually slow and may be incomplete, the guideline does not recommend retreatment unless relapse is shown. Ceftriaxone also is recommended for treatment of children with late neurologic Lyme disease.

The guideline does not recommend macrolide antibiotics as first-line therapy for early Lyme disease; macrolides have been compared with other antimicrobials in clinical trials and are deemed less effective. Macrolides may be used for patients with Lyme disease, however, who are intolerant of, or advised not to be treated with, amoxicillin, doxycycline and cefuroxime axetil. Patients treated with macrolides should be monitored closely for resolution of clinical manifestations.

Additionally, the guideline does not recommend use of first-generation cephalosporins — as they are ineffective against Lyme disease — or ceftriaxone, which is not superior to oral agents and is more likely to cause serious adverse events vs. the recommended orally administered antimicrobials.

Yet, the best treatment for Lyme disease is prevention:

Be cautious when walking in the woods; avoid bushy and grassy areas.
Wear long pants and long-sleeved shirts.
Wear insect repellent containing DEET on exposed skin.
Thoroughly check skin for ticks, paying close attention to the scalp, armpits and groin. If a tick is found, carefully remove it with tweezers.

Additional information may be found at these websites:

http://www.idsociety.org/lymedisease/

http://cid.oxfordjournals.org/content/43/9/1089.full

http://www.cdc.gov/lyme/Treatment/