What Are Treatments for Lyme Disease?

Treatments for Lyme disease vary depending on the stage of infection, symptom severity, and the presence of coinfections. Two major medical organizations—the Infectious Diseases Society of America (IDSA) and the International Lyme and Associated Diseases Society (ILADS)—have published evidence-based treatment guidelines that recommend different approaches to therapy.

The Infectious Diseases Society of America (IDSA) recommends a short course of antibiotics, typically lasting 14 to 30 days. According to IDSA guidelines, the bacteria Borrelia burgdorferi does not persist beyond this timeframe, and lingering symptoms are believed to result from an immune response rather than an ongoing infection.

IDSA also cites scientific evidence suggesting that treatments beyond 30 days are ineffective, unnecessary, and potentially harmful. Under these guidelines, physicians generally stop antibiotic therapy after about one month—even if symptoms persist—although an additional course may be recommended for conditions such as Lyme arthritis.

ILADS treatment approach

The International Lyme and Associated Diseases Society (ILADS) offers a different perspective based on its review of the scientific literature.

ILADS guidelines recognize that a month of treatment may be sufficient for some patients in the early stage of Lyme disease. However, when the infection has disseminated and the disease has progressed, ILADS argues that a 30-day treatment course may be inadequate to fully eradicate the bacteria.

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ILADS guidelines therefore recommend individualized treatment and additional antibiotics when symptoms persist. Treatment duration is often adjusted based on a patient’s response to therapy.

Treating Lyme disease can be complex. Outcomes may be influenced by several factors including:

• The complexity of the Borrelia burgdorferi organism
• Differences in individual immune responses
• The length of time a patient has been infected
• The presence of tick-borne coinfections

Antibiotic options for Lyme disease

Several antibiotic strategies may be used to treat Lyme disease. Depending on the clinical situation, therapy may include oral, intravenous, or intramuscular antibiotics.

Commonly prescribed antibiotics include:

• Doxycycline
• Minocycline
• Amoxicillin
• Cefuroxime
• Azithromycin
• Clarithromycin

In some cases, physicians may also consider:

• Sequential antibiotic therapy
• Higher antibiotic doses
• Combination antibiotic regimens
• Retreatment when symptoms persist
• Evaluation and treatment of tick-borne coinfections

READ MORE: Elderly Lyme disease patients more likely to have unfavorable treatment outcome

Supportive care during Lyme disease treatment

In addition to antibiotics, several supportive strategies may help patients during treatment. These include avoiding alcohol, limiting processed sugars, exercising as tolerated, managing stress, and monitoring symptoms carefully.

Patients may also need counseling about the Jarisch-Herxheimer reaction, a temporary worsening of symptoms that can occur after starting antibiotic therapy.

Regular monitoring of blood counts, chemistries, and liver function tests may also be recommended during treatment.

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Managing treatment risks

As with any antibiotic therapy, side effects may occur. One potential complication is Clostridium difficile–associated diarrhea. Some studies suggest that probiotics may reduce this risk.

In one study, probiotic use significantly reduced the risk of developing C. difficile infection by 60.5%.

Shared decision-making in Lyme disease treatment

Treatment decisions for Lyme disease should involve careful discussion between physicians and their patients. In some cases, consultation with a specialist may be appropriate.

Regular follow-up visits allow clinicians to monitor treatment response and adjust therapy when necessary.

Because Lyme disease presents differently in each patient, treatment decisions should be individualized and based on a patient’s clinical presentation, response to therapy, and overall health.

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention