What Is The Best Antibiotic For Lyme Disease?
Lyme disease make being – Borrelia burgdorferi is sensitive to many antibiotic ( penicillins , cephalosporins , tetracyclines , macrolides , etc . ) and it has not been described subaltern resistances or during discourse . bet on the microscope stage of the disease and the clinical manifestations , one pattern or another is used . In rule , whenever possible , the treatment of choice in the grownup is doxycycline orally .
The direction of adult patients with ahead of time localized or early disseminated Lyme disease , in the presence of migratory erythema and absence of neurologic manifestations and/or nail auriculoventricular ( AV ) mental block , can be performed with 10 - 21 day of unwritten doxycycline 100 mg twice a day , 14 - 21 day of oral Augmentin 500 mg three times a mean solar day or 14 - 21 days of oral cefuroxime 500 mg doubly a day . In case of allergic reaction , intolerance or presence of other contraindications for the use of goods and services of doxycycline , oral azithromycin 500 mg daily for 7 - 10 days , oral clarithromycin 500 mg doubly daily for 14 - 21 days , or unwritten erythromycin 500 mg four times a day for 14 - 21 day is advocate .
Although antibiotic treatment for other Lyme disease is considered effective , there are a substantial symmetry of patient who continue to have clinical manifestations despite handling .
However , to date , there is no evidence to suggest gain resistance of Borrelia to the antibiotics usually used in the discourse of Lyme disease . Circumstantial evidence of ohmic resistance development , in the main to erythromycin , has been report in strains of B. burgdorferi isolate from patients with previous exposure to erythromycin . For children under eight years of age in which the use of tetracyclines is contraindicate , the recommended treatment in place or broadcast early Lyme disease is oral amoxicillin at a dose of 50 mg / kg / daylight , divided into three doses per day , or oral Zinacef 30 mg / kg / sidereal day in two doses a twenty-four hours . patient who have an affectation of the key nervous organization require handling with endovenous ceftriaxone for a maximum of 28 days to see to it adequate penetration of the drug through the blood - brain barrier . The affected role who train cardiac manifestations as auriculoventricular blockage or myopericarditis can be treated with parenteral antibiotic drug or orally for a period of 14 years .
The intra - hospital treatment should be perform with endovenous ceftriaxone 2 g day by day and then continue with unwritten doxycycline as upkeep .
affected role with Lyme arthritis can be treat with oral or endovenous antibiotic drug ; most of them show betterment during the first month of handling . Oral Vibramycin 100 mg twice daily , oral amoxicillin 500 magnesium three times a day or unwritten cefuroxime 500 mg doubly day by day is recommended for 28 day in adult patients in the absence of neurologic manifestations .
For affected role who persist with rheumatologic manifestation after the first month of treatment , a second four - workweek schedule with oral doxycycline , or a 2 - 4 workweek course of endovenous ( IV ) Rocephin . The app of intraarticular steroids and disease - modifying drug are reserved for those affected role who do not the present resolution of the symptom despite the administration of intravenous antibiotics and with results of PCR negative for B. burgdorferi in synovial fluid sample . Approximately one 15 % of patients experience a “ Jarisch - Herxheimer - type reaction ” within 24 60 minutes of starting discourse . This reaction is characterized by an aggravation of systemic symptom and an step-up in the size and number of existing skin lesion . It is important to remind patient role that they can remain diagnostic once the treatment is complete and that , in most showcase , they will continue to show betterment over metre . The treatment of the post - Lyme syndrome is controversial since its pathophysiology is not yet completely known . The post - Lyme syndrome occurs in those patient role who have already been treat adequately for Lyme disease , but who go forward with residuary symptom , mainly arthralgias , fatigue , and cognitive trouble .
There is contestation about whether the post - Lyme syndrome represents a chronic infection or only a non - infectious state of chronic fatigue . This has led to the genesis of polar opinions regarding treatment : some preach prolonged direction with antibiotic , while others are controvert to it .
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