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Amoxicillin Vs Doxycycline For Lyme

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What Is Amoxicillin What Is Doxycycline

Doxycycline and Lyme Disease Treatment

Amoxicillin is a penicillin-type antibiotic used to treat bacterial infections of the middle ear, tonsils, throat, larynx , bronchi , lungs , urinary tract, and skin. It also is used to treat gonorrhea. Other penicillin-type antibiotics include ampicillin , piperacillin , and ticarcillin . These antibiotics stop bacteria from multiplying by preventing bacteria from forming the walls that surround them that are necessary to protect bacteria from their environment and to keep the contents of the bacterial cell together. Bacteria are unable survive without a cell wall. Amoxicillin is effective against many different bacterial strains including H. influenzae, E. coli, Pneumococci, N. gonorrhoea, Streptococci, and some strains of Staphylococci.

Doxycycline is a tetracycline antibiotic used for many different types of infections, including respiratory tract infections due to Hemophilus influenzae, Streptococcus pneumoniae, or Mycoplasma pneumoniae. It also is used to treat non-gonococcal urethritis , Rocky Mountain spotted fever, typhus, chancroid, cholera, brucellosis, anthrax, syphilis, acne, and periodontal disease. Doxycycline works by interrupting the production of proteins by bacteria.

  • rash, and
  • allergic reactions.

People who are allergic to the cephalosporin class of antibiotics, which are related to the penicillins, for example, cefaclor , cephalexin , and cefprozil , may or may not be allergic to penicillins.

Serious but rare reactions include:


Why Doxycycline Alone Isnt Enough

Because Lyme Disease is a result of the spreading of the bacterium Borrelia burgdorferi, it makes sense that a common response is antibiotics. Antibiotics like doxycycline, amoxicillin, and cefuroxime axetil are some of the most commonly used antibiotic treatments for the spread of Lyme Disease.

Antibiotics can be effectively used as a prophylactic dose to reduce the risk of acquiring Lyme Disease immediately after a high-risk tick bite. However, antibiotic treatment helps such a fraction of individuals living with Lyme Disease that it doesnt make sense for this to be the primary treatment. When it comes to treating Chronic Lyme Disease, doxycycline, and other antibiotics, just arent enough and thats because of the nature of Borrelia.

What Are The Side Effects Of Lyme Disease Treatments

Antibiotics, like all medications, have the potential for side effects. Any antibiotic can cause skin rashes, and if an itchy red rash develops while on antibiotics, a patient should see their physician. Sometimes symptoms worsen for the first few days on an antibiotic. This is called a Herxheimer reaction and occurs when the antibiotics start to kill the bacteria. In the first 24 to 48 hours, dead bacterial products stimulate the immune system to release inflammatory cytokines and chemokines that can cause increased fever and achiness. This should be transient and last no more than a day or two after the initiation of antibiotics.

The most common side effect of the penicillin antibiotics is diarrhea, and occasionally even serious cases caused by the bacteria Clostridium difficile. This bacterial overgrowth condition occurs because antibiotics kill the good bacteria in our gut. It can be helpful to use probiotics to restore the good bacteria and microbiome balance.

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Comparing The Efficacy And Safety Of Different Routes Of Administration For Treating Adults Ld

For injectable drugs , cefotaxime and ceftriaxone were more effective than penicillin. Ceftriaxone was more effective than doxycycline . Thus, ceftriaxone and cefotaxime were at the first and second positions in the ranking .

As for the efficacy of oral drugs , the only significant difference was observed in the comparison of amoxicillin versus doxycycline . Subsequently, we assessed the efficacy of different daily dosages . We found that amoxicillin was more effective than azithromycin , doxycycline , and penicillin . Also, azithromycin at 0.25 g and azithromycin at 0.5 g were more effective than penicillin . Penicillin at 1 megaunit was less effective than penicillin at 3 megaunits . Based on the ranking , amoxicillin was the most effective oral drug for treating LD.

Next, we assessed the safety of oral drugs and different oral dosages . For oral drugs amoxicillin plus probenecid was more likely to induce adverse reactions than penicillin . Conversely, there was no significant difference of safety in oral daily dosages .

Drugs Differ Considerably In Their Ability To Sterilize B Burgdorferi Cultures In Pulse Dosing Treatment

Developing New Guidelines on Lyme Disease

Since ceftriaxone pulse dosing could eradicate B. burgdorferi in log phase cultures but not in stationary phase cultures, we wanted to investigate how persister active drug daptomycin and other Lyme antibiotics such as doxycycline and cefuroxime behave in the pulse dosing experiment. We subjected a 10 day old stationary phase culture of B. burgdorferi to daptomycin, doxycycline, and cefuroxime all at 5 g/ml with ceftriaxone as a positive control to four rounds of pulse dosing treatment as described in the section Materials and Methods. Our results showed that daptomycin was less effective than ceftriaxone and had comparable activity with doxycycline after four rounds of pulse dosing treatment . Interestingly, cefuroxime had comparable activity as ceftriaxone after four rounds of pulse dosing treatment . In subculture studies, all the cultures subjected to four rounds of single drug pulse dosing treatment with daptomycin, or doxycycline, or cefuroxime, or ceftriaxone grew back after 21 days , indicating single antibiotic pulse dosing is not able to eradicate stationary phase B. burgdorferi cultures.

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What Is The Best Antibiotic For Lyme Disease

Lyme disease causing organism Borrelia burgdorferi is sensitive to many antibiotics and it has not been described secondary resistances or during treatment. Depending on the stage of the disease and the clinical manifestations, one pattern or another is used. In principle, whenever possible, the treatment of choice in the adult is doxycycline orally.

The management of adult patients with early localized or early disseminated Lyme disease, in the presence of migratory erythema and absence of neurological manifestations and/or complete atrioventricular block, can be performed with 10-21 days of oral doxycycline 100 mg twice a day, 14-21 days of oral amoxicillin 500 mg three times a day or 14-21 days of oral cefuroxime 500 mg twice a day. In case of allergy, intolerance or presence of other contraindications for the use of doxycycline, oral azithromycin 500 mg daily for 7-10 days, oral clarithromycin 500 mg twice daily for 14-21 days, or oral erythromycin 500 mg four times a day for 14-21 days is recommended.

Although antibiotic treatment for early Lyme disease is considered effective, there are a significant proportion of patients who continue to have clinical manifestations despite treatment.

The intra-hospital treatment should be performed with intravenous ceftriaxone 2 g daily and then continue with oral doxycycline as maintenance.

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In Vitro Testing Of Cefovecin

Borrelia burgdorferi strain B31 spirochetes were grown at 34 °C under microaerophilic conditions in modified Barbour-Stoenner-Kelly Medium Complete . Because minimum inhibitory concentrations of most 3rd generation cephalosporins against a variety of Borrelia species fall within 0.015 and 0.125 mcg/ml , a low and high concentration approximately covering this range were selected for testing. Cefovecin 100X stocks were prepared in water and sterile-filtered . The same volume of each stock solution, 40 ul, was added to 4 ml of spirochetes in media for final cefovecin dilutions of 0, 0.02 and 2.0 mcg/ml. Triplicates were prepared for each of the three treatments and monitored for growth over a three day period. Time points for sampling were at 0, 6, 24, 30, 48, and 54 h. Spirochete viability in each sample was based on total motile spirochetes by counting ten random field-of-views via phase contrast microscopy .

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Is Amoxicillinas Effective As Doxycycline For Lyme Disease

You might be askingyourself, Can amoxicillin treat Lyme disease? The answer is yes. Anamoxicillin treatment for early Lyme disease is widely prescribed, but foramoxicillin to have the same efficacy as doxycycline, patients will have totake almost 10 times the amount 500 mg three times a day, for two to threeweeks. Deciding which antibiotic to go with depends on the patients ability tokeep up with the antibiotics course and how far along the disease hasprogressed.

Amoxicillin is alsoprescribed in patients who are pregnant because its still effective againstthe bacteria but doesnt pose the same risks as doxycycline on the pregnancyand unborn child. Doxycycline is also avoided in children under eight yearsold, whereas amoxicillin can be taken by children who have been infected withLyme.

Why Was This Study Needed

Doxycycline – A Tetracycline Class Antibiotic

Lyme disease affects around 2,000 to 3,000 people a year in England and Wales. Although still uncommon, cases have risen in recent years, with warmer winters likely to be a contributing factor. It is caused by an infection with the bacteria Borrelia burgdorferi, spread through infected ticks.

Early symptoms are usually mild. Many people experience a rash that starts around the bite area and may have flu-like symptoms. If left untreated, more serious complications can occur such as nerve pain and heart problems.

Antibiotics are the standard treatment, with doxycycline being the first line antibiotic recommended by NICE. Whilst it is clear they work, the evidence supporting the choice of antibiotic agent is not conclusive. Additionally, the researchers wanted to see if the data pointed to a best treatment regimen and whether dose and treatment length are important.

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The Treatment Of Early Lyme Disease

Christie Choo-Kang, PharmD, BCPSNephrology and Renal Transplant Clinical SpecialistBoston Medical Center

Eileen Tang, PharmD Candidate 2011College of Pharmacy and Allied Health Professions, St. John’s UniversityNew York, New York

Arun Mattappallil, PharmD Candidate 2011College of Pharmacy and Allied Health Professions, St. John’s UniversityNew York, New York

US Pharm.

Lyme disease, also known as Lyme borreliosis, is the most common vector-transmitted illness in the United States.1,2 The disease was first recognized in 1975 in a number of children in Lyme, Connecticut, who were initially diagnosed with juvenile rheumatoid arthritis because of overlapping signs and symptoms.1 In 1982, Willy Burgdorfer, PhD, discovered that a spirochete isolated from Ixodes scapularis, a deer tick, was the same spirochete found in patients with Lyme disease.

Confirmed cases of Lyme disease are defined as erythema migrans greater than 5 cm in diameter or one or more objective late manifestations of Lyme disease with laboratory confirmation in patients with possible exposure to ticks. Healthy People 2010 set a goal of a 44% decrease in the incidence of Lyme disease by 2010. Since 2000, the CDC has contributed more than $3.5 million per year for new research on Lyme disease.2

Drug Combinations Against Borrelia Burgdorferi Persisters In Vitro: Eradication Achieved By Using Daptomycin Cefoperazone And Doxycycline

  • Affiliation Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America

  • Affiliation Fisher Center for Environmental Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America

  • * E-mail:

    Affiliation Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America

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What Are The Risk Factors For Post Treatment Lyme Disease

Risk factors for Post Treatment Lyme Disease include:

  • Delay in diagnosis
  • Increased severity of initial illness
  • Presence of neurologic symptoms

Increased severity of initial illness, the presence of neurologic symptoms, and initial misdiagnosis increase the risk of Post Treatment Lyme Disease. PTLD is especially common in people that have had neurologic involvement. The rates of Post Treatment Lyme Disease after neurologic involvement may be as high as 20% or even higher. Other risk factors being investigated are genetic predispositions and immunologic variables.

In addition to Borrelia burgdorferi, the bacteria that causes Lyme disease, there are several other tick-borne co-infections that may also contribute to more prolonged and complicated illness.

Comparing The Efficacy And Safety Of Antibiotics For Treating Adults And Children With Ld

Antibiotic Doxycycline Works No Better Than Placebo In ...

Network meta-analysis graphs of efficacy and safety of different antibiotics and daily dosages for treating LD. Line width is proportional to the number of studies comparing every pair of treatments. The size of every circle is proportional to the number of patients. Network meta-analysis graph of comparison of drugs efficacy for treating LD. NMA graph of comparison of efficacy of different daily dosages for treating LD. NMA graph of comparison of drugs safety for treating LD. NMA graph of comparison of safety of different daily dosages for treating LD.

Rankings of efficacy and safety of antibiotics and different daily dosages for treating LD and EM. The P score is an indicator of ranking from a scale of 0 to 1. A higher P score indicates higher ranking of antibiotics. The ranking of efficacy of different dosages for treating LD. The ranking of drugs safety for treating LD. The ranking of injectable antibiotic efficacy for treating LD. The ranking of efficacy of different oral dosages for treating LD. The ranking of antibiotic efficacy for treating EM.

Next, we analyzed the efficacy of antibiotics for treating childrens LD we did not observe significant differences of efficacy among these drugs .

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Prevention Of Tick Bites

The best currently available method for preventing infection with B. burgdorferi and other Ixodes-transmitted infections is to avoid tick-infested areas . If exposure to I. scapularis or I. pacificus ticks is unavoidable, a number of measures may help to decrease the risk that ticks will attach and subsequently transmit infection. The use of protective clothing may interfere with attachment by ticks by increasing the time required for ticks to find exposed skin, thus facilitating their recognition and removal. By wearing light-colored clothing , persons in areas of endemicity may also be more likely to see ticks before they have attached.

Daily inspections of the entire body to locate ticks also provide an opportunity to prevent transmission of tick-borne infections . Attached ticks should be removed promptly with fine-toothed forceps, if possible . Tick and insect repellents applied to the skin and clothing provide additional protection .

What Does Current Guidance Say On This Issue

NICE guidance on Lyme disease states that those without focal symptoms should receive 100mg oral doxycycline twice a day or 200mg once per day for 21 days. The first alternative to this is oral amoxicillin, 1g three times per day for 21 days and the second alternative is oral azithromycin, 500mg daily for 17 days.

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Conflict Of Interest Statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The reviewer NBDC and handling Editor declared their shared affiliation and the handling Editor states that the process nevertheless met the standards of a fair and objective review.

Chronic Lyme Disease Or Postlyme Disease Syndrome

Doxycycline Side Effects | Uses | Doxycycline Precautions & Best Practices

Following an episode of Lyme disease that is treated appropriately, some persons have a variety of subjective complaints . Some of these patients have been classified as having chronic Lyme disease or postLyme disease syndrome, which are poorly defined entities. These patients appear to be a heterogeneous group. Although European patients rarely have been reported to have residual infection with B. burgdorferi , this has yet to be substantiated either in a large series of appropriately treated European patients or in a study of North American patients. Residual subjective symptoms that last weeks or months also may persist after other medical diseases . It has also been recognized that the prevalence of fatigue and/or arthralgias in the general population is > 10% .

In areas of endemicity, coinfection with B. microti or the Ehrlichia species that causes HGE may explain persistent symptoms for a small number of these patients . Randomized controlled studies of treatment of patients who remain unwell after standard courses of antibiotic therapy for Lyme disease are in progress. To date, there are no convincing published data showing that repeated or prolonged courses of oral or iv antimicrobial therapy are effective for such patients. The consensus of the IDSA expert-panel members is that there is insufficient evidence to regard chronic Lyme disease as a separate diagnostic entity.

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Ceftriaxone Pulse Dosing Sterilized Log Phase Culture But Fails To Do So For Stationary Phase B Burgdorferi Culture Enriched With More Resistant Biofilm

FIGURE 1.Effect of ceftriaxone pulse dosing on 5 day old log phase and 10 day old stationary phase Borrelia burgdorferi cultures. Log phase and stationary phase B. burgdorferi cultures were treated with pulse dosing of 5 g/mL ceftriaxone as described in the section Materials and Methods followed by staining by SYBR Green I/PI assay and fluorescence microscopy at 100× magnification. Abbreviation: Sta., stationary.

To confirm the results of the SYBR Green I/PI microscopy assay, we performed subculture test in fresh BSK-H medium as in our previous study . The results showed that the 5 day log phase culture treated with four rounds of ceftriaxone pulse dosing did not regrow after 7 and 21 days subculture . The four rounds of ceftriaxone pulse dosing treated 10 day old stationary phase culture did not show signs of regrowth after 7 day subculture despite the presence of some microcolony forms of B. burgdorferi . However, after 21 day subculture, about 3 × 106 regenerative spirochetes per milliliter in the stationary phase subculture were observed . These results suggest that although four rounds of ceftriaxone pulse dosing treatment could eliminate planktonic log phase B. burgdorferi spirochetal forms and even round body forms, it failed to eradicate the more resistant aggregated microcolony forms of B. burgdorferi in the stationary phase culture.

What Did It Find

  • Compared to doxycycline, there was no difference between the following antibiotics for treatment response by 12 months: penicillin V , azithromycin , cefuroxime axetil , amoxicillin or ceftriaxone plus doxycycline .
  • More than 80% of patients showed a treatment response, 84% at two or fewer months after starting treatment and 80% at 12 or more months following treatment initiation. There was no available data on outcomes for around 15%.
  • There were few treatment failures in those people who were followed up 4% by two months and 2% by 12 months.
  • Treatment-related adverse effects occurred in around 31% of people and included vomiting and diarrhoea as well as a Herxheimer-like reaction . Only 1% experienced haematologic adverse events, such as low platelet counts.

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