He Asked What Many Eventually Ask
He sat across from me and voiced something countless patients eventually reach: Doctor… do I need IV antibiotics?
The patient struggled with cognitive slowing, neuropathic pain, persistent headaches, sleep disruption, and mild dizziness. He was improving slowly with oral antibiotics — but anxious he was missing something.
He had seen images of patients with IV poles on social media and heard stories of recovery only after patients had been treated with IV antibiotics. He believed IV therapy represented the “real treatment.” He wasn’t alone. Many assume IV antibiotics are stronger, faster, or required.
What IV Antibiotics Can (and Can’t) Do in Recovery
IV antibiotics can help in some cases of Lyme disease, especially when there is significant neurological involvement and oral treatments haven’t brought noticeable improvement or symptoms keep getting worse.
However, IV therapy is not simply a stronger version of oral treatment. It carries catheter-related risks, varies in what it covers, and does not guarantee better outcomes. For some patients, it offers benefit; for others, progress occurs through different strategies. IV is a tool — not a universal upgrade.
Why Some Patients Don’t Improve Even After IV Therapy
Many patients aren’t aware that the most commonly used IV antibiotic for Lyme — ceftriaxone — doesn’t treat co-infections like Babesia, Bartonella, or Anaplasma.
If one of these infections is present, IV therapy alone may not help, even when it’s given correctly.
In many cases, it’s a mismatch in coverage, not a lack of effort, that explains why some people don’t get better after IV treatment.
How I Decide When IV Antibiotics Makes Sense
Many antibiotics offered in IV form — including doxycycline and azithromycin — exist orally with good tissue penetration and far fewer catheter-related risks.
Other IV antibiotics are still being studied, so I usually use them only in specific situations rather than as a first step or automatic next step.
Even when IV therapy is appropriate, drug selection matters. Ceftriaxone, for example, can affect the gallbladder, so in patients with prior concern, cefotaxime (Claforan) may be an alternative — though it requires far more frequent dosing.
The Turning Point Was Not IV — It Was Correct Treatment
Because Babesia was clinically suspected, we adjusted the patient’s oral regimen to include azithromycin (Zithromax) and Malarone.
His cognition sharpened. Neuropathy eased. Headaches settled. Sleep stabilized. Dizziness quieted.
A few weeks later he said, “I thought IV was my only shot. I didn’t realize I could get better without it.”
He never required IV treatment — he needed the right treatment, not a different route.
Sometimes progress isn’t escalation — it’s correction.
“Do I Need IV Antibiotics?”
When someone asks, “Do I need IV antibiotics?” the answer depends on symptoms, function, and treatment response.
There are situations where IV therapy is justified. But many improve when treatment is refined, not intensified.
If improvement stalls despite appropriate care — or neurological involvement is suspected — IV therapy may be considered.
But many regain ground when treatment targets co-infections and physiologic drivers.
If you have wondered whether you truly needed IV antibiotics, you are not alone. Share your experience below — someone else may feel less alone reading it.
Resources
- Columbia University. Lyme and Tick-Borne Diseases Research Center.
- CDC. Chronic Symptoms and Lyme Disease.
- Johns Hopkins Lyme Disease Research Center.
- Dr. Daniel Cameron: Lyme Science Blog. What Is the Best Treatment for Lyme Disease?
- Dr. Daniel Cameron: Lyme Science Blog. Lyme disease: One size does not fit all
