Lyme Disease

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

Quick GuideLyme Disease Symptoms, Rash, Treatments

Lyme Disease Symptoms, Rash, Treatments

What are Lyme disease treatments? What is the prognosis of Lyme disease?

Lyme disease is usually curable with antibiotics. This is so true that some authors of Lyme disease research have stated that the most common cause of lack of response of Lyme disease to antibiotics is a lack of Lyme disease to begin with! The type of antibiotic depends on the stage of the disease (early or late) and what areas of the body are affected. Early illness is usually effectively treated with medications taken by mouth, for example, doxycycline (Vibramycin), amoxicillin (Amoxil), or cefuroxime axetil (Ceftin). This antibiotic therapy generally result in a rapid cure of Lyme disease. Of note, doxycycline should not be used in pregnancy or in children under 8 years of age.

Therefore, if a person finds a typical bull's-eye skin rash (described above) developing in an area of a tick bite, they should seek medical attention as soon as possible. Generally, antibiotic treatment resolves the rash within one or two weeks with no long-term consequences. Later illness such as nervous-system disease might require intravenous drugs; examples are ceftriaxone (Rocephin) and penicillin G. There are no home remedies to treat Lyme disease.

In those people with two or more episodes of erythema migrans rash, even years apart, it is felt that the episodes represent different infections or reinfection rather than persistence of the original infection.

For relief of Lyme disease symptoms, pain-relieving medicines might be added. Swollen joints can be reduced by the doctor removing fluid from them (arthrocentesis). An arthrocentesis is a procedure whereby fluid is removed from a joint using a needle and syringe under sterile conditions. It is usually performed in a doctor's office. Rarely, even with appropriate antibiotics, the arthritis continues. It has been suggested by researchers that sometimes joint inflammation can persist even after eradication of the Lyme bacteria. This complication has been explained as an ongoing autoimmune response causing inflammation of the joint that was initially stimulated by the original bacterial infection. Oral medications such as ibuprofen (Motrin, Nuprin) can also be used to reduce inflammation and improve function. There is no evidence that nonspecific fatigue that persists after treatment for Lyme disease is related to persistent infection. The risks of prolonged treatments with antibiotics are far greater than any benefit in this situation.

Of note, recent research was done to study whether longer-term antibiotic treatment of persistent symptoms of Lyme disease led to any better outcomes than shorter-term treatment. The study found that longer-term antibiotic treatment did not have additional beneficial effects on health-related quality of life beyond those with shorter-term treatment. Specifically, the researchers determined that this longer-term antibiotic treatment had no more beneficial effect on fatigue, or musculoskeletal, neuropsychological, or cognitive symptoms and disorders from Lyme disease than placebo.

Reviewed on 7/13/2017
References
REFERENCES:

Berende, Anneleen, et al. "Randomized Trial of Longer-Term Therapy for Symptoms Attributed to Lyme Disease." N Engl J Med 374 (2016): 1209-20.

International Lyme and Associated Diseases Society (ILADS).

Klippel, John H., et al., eds. Primer on the Rheumatic Diseases. 13th ed. New York: Springer and Arthritis Foundation, 2008.

"Lyme Disease." Infectious Diseases Society of America. <http://www.idsociety.org/Lyme/>.

Shapiro, E.D. "Lyme Disease." N Engl J Med 370.18 (2014): 1724-1731.

United States. Centers for Disease Control and Prevention. "Lyme Disease." May 27, 2017. <https://www.cdc.gov/lyme/index.html>.

Wright, William F., et al. "Diagnosis and Management of Lyme Disease." American Academy of Family Physicians 85.11 June 1, 2012: 1086-1093. <http://www.aafp.org/afp/2012/0601/p1086.html>.

IMAGES:

1.CDC - James Gathany

2.iStock

3.iStock

4.CDC

5.Interactive Medical Media LLC. All rights reserved./"Bullseye Lyme Disease Rash" by Hannah Garrison

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