Single dose of doxycycline for Lyme disease led to poor outcome for 61-year-old man

Ever wonder what the outcome might be if a patient were prescribed a single dose of oral doxycycline for Lyme disease? Not so good, according to a case report by Ebner and colleagues from the Mayo Clinic in Rochester, Minnesota. [1]

In the January 2018 issue of the British Medical Journal, the authors describe the case of a 61-year-old man who complained to his primary care physician and multiple emergency room personnel that he was having severe shooting pain over his scalp, neck and back.

“The degree of discomfort from his hair moving was so extreme he elected to shave his head to provide some relief,” writes Ebner. The man also presented with non-radiating back pain and bilateral dorsal arm paresthesias.

He reported having “three distinct large circular red lesions, one with a central clearing,” writes Ebner. However, his serologic and spinal tap results were normal.

The man had been exposed to ticks, “working outside optimizing the landscape for white tailed deer,” states Ebner. He had also been exposed to at least 30 ticks in 1 day, but did not recall a tick bite.

The initial doctors did not prescribe the treatment regime of at least 3 weeks of antibiotics, as recommended by both the Infectious Diseases Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS).

Instead, the man was prescribed a single dose of doxycycline 200 mg. And physicians attempted to manage his symptoms with pain medications. “He had been up-titrated on gabapentin with minimal response and started on a narcotic for pain control,” the authors explain.

For the next 6 weeks, the man continued suffering with severe pain, worsening paresthesias, and right-sided cranial nerve VII palsy.

His repeat spinal tap was abnormal for lymphocytosis, elevation of protein, 6 oligoclonal bands, and a positive ELISA and IgG and IgM immunoblot. Physicians then diagnosed him with early Lyme neuroborreliosis and prescribed a 28-day course of intravenous ceftriaxone.

“After completion of antibiotic therapy, the patient reported feeling significantly improved,” explains Ebner. He did, however, continue to have some weakness on the right side of his face, along with intermittent back pain that was managed with gabapentin.

The 61-year-old man might have avoided 6 weeks of pain and suffering, narcotics, a repeat spinal tap, intravenous antibiotics, weakness of his face in the lower motor neuron pattern and back pain if he had been treated with at least 3 weeks of antibiotics, instead of a single dose of doxycycline.

Related Articles:

Single dose of prophylactic treatment of a tick bite only prevents a Lyme rash

Case report: persistent pain and fatigue after treatment for Lyme disease

At least 50% of patients with Lyme neuroborreliosis remain ill years after treatment


  1. Ebner D, Smith K, DeSimone D, Sohail MR. Cranial neuropathy and severe pain due to early disseminated Borrelia burgdorferi infection. BMJ Case Rep. 2018;2018.

36 Replies to "Single dose of doxycycline for Lyme disease led to poor outcome for 61-year-old man"

  • Kaydi
    11/18/2020 (10:40 am)

    I have removed multiple deer ticks from myself and my dogs this season. I came down with a fever, chills, severe joint aching and I couldn’t move my right arm. I touched my back beneath my shoulder and it was hot and sensitive. When looking in the mirror I saw the lymes rash 4×4 inches wide. I went straight to the doc and was prescribed 3 weeks doxycycline 100 mgs 2x a day. I haven’t received my blood test results yet. Doc said if blood comes back negative for lymes to stop medication? I feel like I may be in early stage where the infection may not be detected so I’ve decided to continue with antibiotics whether positive or not. Make sense????

    • Dr. Daniel Cameron
      11/19/2020 (7:28 am)

      Makes sense to me. I often find the test to be negative early in the disease. Moreover, the antibiotics may be helpful for Lyme disease but can interfere with the test. I also encourage a followup treatment before the treatment is finished to determine if i have a good outcome.

  • Patty
    11/17/2020 (10:45 am)

    Hi Dr. Cameron, I just found your page and this article searching for the single dose doxycycline issue. We go hiking often, usually on trails. My husband found a tick on him last week, on Nov 12. He removed it as the tick wasn’t completely attached, the head was still on it. He was able to get a phone appointment with his primary care physician for Nov 16. Doctor said, since it was a recent bite, the SINGLE DOSE doxycycline (2 tablets, 100mg each taken together) should be enough. He took the tablets the same night with dinner. Would that be enough to prevent Lyme? What he should be aware of in the coming days? Weeks? Should he ask for an actual treatment of several weeks? (We’re in Ontario, Canada, the medical system is always pretty rationed here).
    Thank you in advance!!!

    • Dr. Daniel Cameron
      11/17/2020 (3:13 pm)

      I am not in favor of a single 200 mg dose of doxycycline.Others disagree. The study supporting a single dose of doxycycline was tiny ( 8 rashes in the treatment group versus 1 rash in the placebo group). The study did not look at whether a single dose were effective for other Lyme disease manifestations.

  • Jan
    10/31/2020 (7:29 pm)

    Hi Dr C, I am glad to find your page. I would be interested to know your opinion on how many weeks of doxycycline you think that I should receive. I got bitten back in the middle of August, but I am only getting treated now for Lyme disease. Do you think 3 weeks treatment of 100mg twice per day is enough?

    • Dr. Daniel Cameron
      11/01/2020 (8:03 am)

      I have Lyme disease patients in my practice that are well. Some are not so well. I prefer 4 weeks to start with a visit at 4 weeks to reassess response to treatment. I find 4 to 6 week to start most helpful for my patients as long as I have followup.

  • Ilona Paulauskas
    06/22/2020 (3:54 pm)

    I have had chronic Lyme disease for14 years because my doctor failed to diagnose it. 5 years later I found out another way. I was given 6 weeks of doxycycline.Now 9 years later I was feeling fatigued and more forgetful and achy. A new doctor for me prescribed 2 weeks of Doxycycline. Is that enough?

    • Dr. Daniel Cameron
      06/22/2020 (6:59 pm)

      I typically treat my patients longer. I have them return for follow-up to determine if I should extend treatment or change treatment. Call my office in Mt. Kisco at 914 666 4665 if you need help.

  • Dave Gill
    07/27/2019 (1:36 pm)

    I was prescribed 2 doses of 100 mg a day for 21 days, would it be ok to take both doses at once, as in 200mg instead doing 100 mg twice a day.

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