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These drugs kill Borrelia burgdorferi bacteria, which cause Lyme disease.
Antibiotics are used to cure early Lyme disease and to greatly reduce the risk of future complications. Antibiotics may also be used in the later stages of Lyme disease, when additional symptoms involving the skin, joints, nervous system, or heart may develop.
The type of antibiotic prescribed depends on your age, symptoms, and stage of Lyme disease. These medicines may be taken orally, as an injection, or through a vein (intravenous, or IV). The length of antibiotic treatment varies according to how bad the disease and your symptoms are, but treatment generally lasts less than 4 weeks.
Antibiotics are most effective in helping cure Lyme disease when they are taken early in the course of the disease.1 Early treatment with antibiotics can help prevent future problems with arthritis, the heart, or the nervous system. But symptoms may not go away right away. Some symptoms may last for several weeks after treatment. This does not mean that the antibiotics were not successful, nor does it mean that you need additional antibiotic treatment.
Antibiotic treatment for early symptoms of chronic Lyme arthritis is usually very effective. Joints that have been badly damaged by Lyme arthritis may take a long time to get better after the infection has been cured, or they may not respond to treatment at all. A small percentage of people continue to have symptoms of chronic Lyme arthritis after treatment with antibiotics.2
Heart symptoms often begin to go away before antibiotics are given. If not, they usually respond to antibiotic therapy within days. Mild heart symptoms that may occur with early Lyme disease usually improve after treatment with oral amoxicillin or doxycycline for 21 to 30 days.
Symptoms of inflammation of the membrane surrounding the brain and spinal cord (Lyme meningitis) begin to improve by the second day of therapy and usually disappear after 7 to 10 days.
Common side effects of these antibiotics include:
Some people treated for early Lyme disease have brief episodes of headache, muscle and joint pain, and fatigue that may continue for an extended period of time after treatment. These symptoms usually go away on their own within 6 months and do not require further treatment.
During the first 24 hours of antibiotic therapy, you may have a higher fever, redder rash, or greater pain. This is not an allergic reaction to the drug. It may mean that the bacteria are rapidly dying.
One large study suggests that people who take erythromycin along with certain common medicines may raise their risk of sudden cardiac death.3 The study showed that the risk of sudden cardiac death is greater when erythromycin is taken with some medicines that inhibit certain liver enzymes—such as certain calcium channel blockers, certain antifungal medicines, and some antidepressants—than when these medicines are not taken together.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
The dosage of antibiotic given and the duration of treatment should be based on your age and body weight, how bad the illness is, and how you respond to treatment.
Doxycycline should be taken with plenty of fluids and not while you are lying down or right before bedtime.
If you get intravenous (IV) antibiotics, you may have weekly blood tests to check your white blood cell count. The IV antibiotic treatment may lead to low levels of white blood cells (called leukopenia) that can make it hard for you to fight infection.
With the exception of pregnant women and people with severe arthritis or heart problems, most people who have been exposed to ticks but do not have symptoms are not given antibiotics. Even in parts of the country where Lyme disease is known to occur often, the risk of getting Lyme disease is too small to warrant treatment before symptoms appear.
Doxycycline is the drug of choice for treating early Lyme disease in people ages 8 and older. But it should not be given to pregnant women or to people who are allergic to tetracycline.
- Sharma SK, Kadhiravan T (2009). Lyme disease. In RE Rakel, ET Bope, eds., Conn's Current Therapy 2009, pp. 136–139. Philadelphia: Elsevier Saunders.
- Steere AC (2010). Borrelia burgdorferi (Lyme Disease, Lyme Borreliosis). In GL Mandell et al., eds., Principles and Practices of Infectious Diseases, 7th ed., chap. 239, pp. 3071–3081. Philadelphia: Elsevier Churchill Livingstone.
- Ray WA, et al. (2004). Oral erythromycin and the risk of sudden death from cardiac causes. New England Journal of Medicine, 351(11): 1080–1096.
Last Revised: April 20, 2012
This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.