Lyme Disease

The treatment for Lyme disease is antibiotic therapy; however, overprescribing of antibiotics can lead to serious problems, so the decision to treat must be made with care. Disease organisms can develop resistance to families of medications over time, rendering the drugs useless. Furthermore, testing and treatments can be expensive. If a patient has strong indications of Lyme disease (symptoms and medical history), the doctor will probably begin treatment on the presumption of this disease. The American College of Physicians recommends treatment for a patient with a rash resembling EM or who has arthritis, a history of an EM-type rash, and a previous tick bite.

The benefits of treating early must be weighed against the risks of overtreatment. The longer a patient is ill with Lyme disease before treatment, the longer the course of therapy must be, and the more aggressive the treatment. The development of opportunistic organisms may produce other symptoms. For example, after long-term antibiotic therapy, patients can become more susceptible to yeast infections. Treatment may also be associated with adverse drug reactions. Another concern is that insurance coverage for long-term antibiotic therapy may be limited by the insurer or by law in some states.

For most patients, oral antibiotics (doxycycline or amoxicillin) are prescribed for 21 days. When symptoms indicate nervous system involvement or a severe episode of Lyme disease, intravenous antibiotic (ceftriaxone) may be given for 14-30 days. Some physicians consider intravenous ceftriaxone the best therapy for any late manifestation of disease, but this is controversial. Corticosteroids (oral) may be prescribed if eye abnormalities occur, but they should not be used without first consulting an eye doctor.

The doctor may have to adjust the treatment regimen or change medications based on the patient's response. Treatment can be difficult because Bb comes in several strains (some may react to different antibiotics than others) and may even have the ability to switch forms during the course of infection. Also, Bb can shut itself up in cell niches, allowing it to hide from antibiotics. Finally, antibiotics can kill Bb only while it is active rather than dormant.

Therapy will not be effective, no matter which drugs are chosen, unless the doctor's instructions are followed. Medication must be taken in the correct amounts at the times indicated, alcohol consumption should be avoided during treatment, and the patient should rest regularly, preferably before the onset of fatigue.