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"

  • Eduardo Rodriguez
    01/19/2023 (12:13 pm)

    Dr. Dont want to believe anything that they cant see. If he said he was around ticks and now he has lymes symptoms. Why not give him full course of antibiotics. Dr. Let people suffer because they are afraid of bacteria become immune to antibiotics. But people should suffer. A-specially because someone thinks they know it all. I have been dealing with lymes for over 1 1/2yrs now all because dr. Refuse to look at my symptoms and rely on test to much. Before all these fancy test dr. Relied on what they new or seen. All my test were negative For a hole year. I suffered and still am. Because I wouldn’t be listened to. Now all my test are positive for lymes. And no antibiotics work because they waited to long. So i live everyday miserable with brain fog and major headaches DAILY, EVERY DAY. So if u think u may be sick dont stop until u feel ok with the assessment. Its your body and life. Not the dr. They go home happy with pocket full of money.

  • Kristy
    08/11/2022 (9:52 am)

    Dr. Cameron! I was diagnosed with lyme 2 years ago and was treated with 2 separate times with doxy. It took awhile but I eventually got better.. Fast forward to now. I live in a rural community where ticks are everywhere. I haven’t seen a tick on me, atleast not attached. I did have one crawling on my shirt. But I have had a few strange bites I noticed on my neck and leg.I started feeling ill a few weeks ago and was sure lyme got me again. I was tested for lyme and I just received my results on the portal. Which were negative. I had one postive band IGG 41 ( I believe that is a old infection), And One postive band IGM 23. Doesn’t that signal a new infection? My doctor hasn’t called me yet about the result but I highly doubt she will treat me due to the negative results. I do have a older prescription of doxy ( not expired), from January that I was given for another condition, but I never needed to take them, once my bloodwork came back negative. I really feel I should, just to be safe.

    • Dr. Daniel Cameron
      08/12/2022 (7:19 am)

      The proposed single 200 mg dose of doxycycline only works if prescribed within72 hours of a known tick bite. I am not convinced a single dose prevents manifestations of Lyme disease other than a rash. A single dose of doxycycline has not been shown to be effective if you are already ill. I don’t find that single band helpful. I do encourage my patients to have an evaluation by a doctor experienced in treating Lyme disease if their doctor cannot find an answer.

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