Treatment Of Erythema Migrans Rash
People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Early diagnosis and proper antibiotic treatment of Lyme disease can help prevent late Lyme disease. Treatment regimens listed in the following table are for the erythema migrans rash, the most common manifestation of early Lyme disease. These regimens may need to be adjusted depending on a persons age, medical history, underlying health conditions, pregnancy status, or allergies. Consult an infectious disease specialist regarding individual patient treatment decisions. For treating other manifestations, see www.cdc.gov/Lyme/treatment.
|30 mg/kg per day orally, divided into 2 doses||500 mg per dose||14|
*When different durations of antibiotics are shown to be effective for the treatment of Lyme disease, the shorter duration is preferred to minimize adverse effects, including infectious diarrhea and antimicrobial resistance.
NOTE: For people intolerant of amoxicillin, doxycycline, and cefuroxime, the macrolide azithromycin may be used, although it is less effective. People treated with azithromycin should be closely monitored to ensure that symptoms resolve.
How Is Lyme Disease Diagnosed
A healthcare provider will diagnose Lyme disease based on symptoms, physical findings and whether or not you’ve been in an area populated by infected ticks.
Many people dont remember or know that theyve been bitten by a tick. This is because the tick is tiny, and its bite is usually painless.
Your provider will confirm the diagnosis using a blood test. If your first blood test is negative for Lyme disease, you won’t need another test. If the first test is positive or equivocal, your provider will conduct the test again. You have to have two positive results to be diagnosed with Lyme disease.
For Depression And Anxiety
Both psychotherapy and pharmacotherapy have proven benefits for improving mood. Psychotherapy has many different types such as supportive, dynamic, cognitive behavioral, dialectical behavior therapy, transference focused psychotherapy each of which offers benefit. Pharmacotherapy also has many different types. For depression the first-line options usually are SSRIs, SNRIs, Tricyclics or other agents with more unique modes of action.
A few noteworthy tips on anti-depressant agents:
- Most anti-depressant agents also help in reducing anxiety. However the opposite isn’t necessarily true. Specific anti-anxiety agents such as clonazepam or diazepam may not necessarily help fight depression.
- Most anti-depressants take three to eight weeks before an effect is seen. Therefore, it is unwise to stop an anti-depressant after only three or four weeks, as staying on it another two to three weeks may lead to a good response.
- Dosage makes a difference. Some anti-depressants work fine at low doses some medications however are effective only at higher doses. Some medications are more effective as the dose is increased. Other antidepressants may have a therapeutic range one has to achieve at least a certain dosage .
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Treatment For Chronic Lyme Disease
Sometimes, people go through treatment for Lyme disease but their symptoms donât go away. If this lasts over 6 months, itâs known as chronic Lyme disease or âpost-treatment Lyme disease syndromeâ .
Doctors still arenât sure why some people get PTLDS. Some believe that getting Lyme disease may cause damage to your tissues or immune system. Others believe itâs because the bacteria that causes Lyme hasnât completely gone away.
There is little evidence that taking more antibiotics at this stage will help. They may actually be harmful. Instead, your doctor will focus on treating the symptoms youâre still having. This will be different for everyone. Some people could benefit from a medicine that relieves fatigue, while others may need a drug that can help with headaches or very sensitive skin.
Your doctor could also have you try a treatment that helps people with chronic fatigue syndrome or fibromyalgia.
More research is needed to figure out how best to treat PTLDS. Itâs something that can be frustrating. Just remember: Many people who have this condition do start feeling like their old selves after a few months.
Hunting For Alternative Drug
Frustrated by the lack of treatment options for Lyme disease patients with lingering symptoms, Rajadas and his team began hunting for a better alternative in 2011. In 2016, they published a study in Drug Design, Development and Therapy that listed 20 chemical compounds, from about 4,000, that were most effective at killing the infection in mice. All 20 had been approved by the Food and Drug Administration for various uses. One, for instance, is used to treat alcohol abuse disorder.
In this most recent study, azlocillin, one of the top-20 contenders, was shown to eclipse a total of 7,450 compounds because it is more effective in killing B. burgdorferi and causes fewer side effects. Lyme disease affects more than 300,000 people annually, according to the Centers for Disease Control and Prevention. It can affect various organs, including the brain, skin, heart, joints and nervous system, and cause heart problems and arthritis if untreated. Symptoms include fever, headaches, chills, and muscle and joint pain.
Traditional antibiotics, such as doxycycline, are effective as an early course of treatment for the infection in the majority of patients, but it remains unclear why these drugs fail to treat 10% to 20% of patients, Rajadas said.
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How Can Lyme Disease Go Dormant Following Antibiotic Treatment
Did you know that Lyme disease, a bacterial infection transmitted by ticks, can go into remission following antibiotic treatment?
Its true! Unfortunately, this isnt necessarily good news for the person who has it and is cured of the infection.
Lyme disease can cause long-term health problems if left untreated or undiagnosed.
This means that while an infected person may be cleared of symptoms at first glance and given antibiotics to eliminate their infection, they could still have the disease lurking in their system.
Selection Criteria And Methods
One reviewer screened citations and selected studies. In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved and assessed for inclusion. The final selection of full-text articles was based on the inclusion criteria presented in .
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Lyme Disease Or Stari
An erythema migrans-like rash has also been described in humans following bites of the lone star tick. This condition has been named Southern Tick-Associated Rash Illness . Although the rash may be accompanied by systemic symptoms, disseminated or severe disease has not been reported. Because the cause of STARI is unknown, diagnostic blood tests are not available. It is not known whether antibiotic treatment is necessary or beneficial for patients with STARI. Nevertheless, because STARI resembles early Lyme disease, physicians often treat patients with the same antibiotics recommended for Lyme disease.
Lone star ticks can be found from central Texas and Oklahoma eastward across the southern states and along the Atlantic Coast as far north as Maine.
What Is The Outlook For Someone With Lyme Disease
Most of the people who get Lyme disease and receive treatment early will be fine. Treatment can cure Lyme disease but you might still have some long-term effects. Untreated Lyme disease may contribute to other serious problems but its rarely fatal.
Post-treatment Lyme disease syndrome
Even after proper treatment, some people may experience lingering fatigue, achiness or headaches. This is known as post-treatment Lyme disease syndrome or PTLDS. The symptoms dont mean that you still have an infection. PTLDS probably wont respond to additional antibiotics. The majority of people in this group will have symptoms that resolve at some point over the next six months.
Chronic Lyme disease
Chronic Lyme disease is a term used by some for a condition in a person who had Lyme disease and the symptoms of PTLDS. Some people consider chronic Lyme disease to be the same as PTLDS. However, some people receive a chronic Lyme disease diagnosis without a Lyme disease diagnosis. Sometimes, extended treatment with antibiotics helps.
This term may be why some people think a Lyme disease infection can occur without being bitten by a tick. There isn’t enough proof that mosquitoes can transmit Lyme disease. Many researchers dislike using the term chronic Lyme disease.
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Home Remedies For Lyme Disease
Some potential home remedies for lyme disease include taking probiotics, drinking plenty of fluids, getting adequate rest, and avoiding caffeine and alcohol. Additionally, some people may find relief from certain supplements or herbs, such as garlic, ginger, and turmeric.
Probiotics are good bacteria that help keep the gut healthy. Some studies have shown that probiotics may be helpful in treating lyme disease. One study found that a probiotic called Bacteroides fragilis helped improve symptoms in people with lyme disease. Another study showed that a probiotic called Lactobacillus rhamnosus GG was helpful in preventing relapse of lyme disease.
Drinking enough fluids is also another way to help treat lyme disease. When youre dehydrated, your body has to work harder to function, which can worsen the symptoms of lyme disease. Staying hydrated will help your body fight the infection and recover more quickly. Try to drink plenty of water and other fluids throughout the day, especially if youre feeling sick.
Getting adequate rest is important for anyone, but especially for those who are suffering from lyme disease. When youre tired, your body is working harder to do everything, including fighting off infection. Make sure youre getting enough sleep every night and taking breaks during the day to relax and rejuvenate. This will help your body focus its energy on healing itself.
Blood Tests For Antibodies
Blood tests for detecting antibodies to B. burgdorferi are most reliable several weeks after infection has occurred and are rarely of value during the first 7 to 10 days of illness. During these initial days of infection, these tests can give false negative results .
Most authorities, including the CDC, recommend a 2-step testing process for Lyme disease:
- EIA Test. The first test used is an enzyme immunoassay . The EIA measures IgM and IgG antibodies to the B. burgdorferi spirochete. Positive results from this test still require confirmation with a Western blot test, since the EIA test is often positive even when there has been no infection. Negative results do not require further testing.
- Western Blot or second EIA test. If the EIA test is positive or uncertain, it is followed by the Western blot test. This test is more accurate and is very helpful in confirming the diagnosis but is more expensive and takes longer to complete. The Western blot creates a visual graph showing bands of IgM or IgG antibodies that laboratories use to interpret the immune response. More recently, recommendations have changed to allow for a second EIA in place of the confirmatory Western blot .
- V1sE . This newer FDA-approved test detects a specific component within the EIA IgG antibodies and is being increasingly used instead of the Western Blot to confirm a positive EIA test. Since it is less expensive and more rapidly completed, it may ultimately replace the Western Blot test.
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The Cycle Of Infection
The blacklegged tick has a 2-year life cycle during which it goes through 3 stages of development:
- Egg. Adult females lay eggs during the spring of year 1. Eggs are deposited usually on the ground in the area where the female detached from its host.
- Larva Stage. In spring and summer of year 1, 6-legged larvae hatch from eggs. They take their first meal from a mouse, bird, or other small animal. This is when larvae can first acquire the B. burgdorferi spirochete but they do not transmit it at this stage. After feeding, the larvae fall off their hosts and molt into nymphs, which become dormant for the fall and winter of year 1.
- Nymph Stage. In the spring and summer of year 2, the 8-legged nymph ticks wake up and begin to feed on wild animals , domestic animals , or humans. Peak activity is usually from late May through July, although this can vary depending on climate. Most cases of Lyme disease are transmitted by nymphs.
- Adult Stage. In the fall of year 2, the nymphs become 8-legged adults. Only the adult female takes a blood meal. Adult female ticks may also transmit Lyme disease. For their third and final meal, female ticks seek a larger animal. After feeding, they mate with males, drop off the host, lay eggs, and then die. White-tailed deer are the main hosts for adult ticks. Female ticks feed on deer, while male ticks attach themselves to deer to wait for the females.
Keep in mind that:
What Is Post Treatment Lyme Disease
Post Treatment Lyme Disease represents a research subset of patients who remain significantly ill 6 months or more following standard antibiotic therapy for Lyme disease. PTLD is characterized by a constellation of symptoms that includes severe fatigue, musculoskeletal pain, sleep disturbance, depression, and cognitive problems such as difficulty with short-term memory, speed of thinking, or multi-tasking. In the absence of a direct diagnostic biomarker blood test, PTLD has been difficult to define by physicians, and its existence has been controversial. However, our clinical research shows that meticulous patient evaluation when used alongside appropriate diagnostic testing can reliably identify patients with a history of previously treated Lyme disease who display the typical symptom patterns of PTLD.
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Critical Appraisal Of Individual Studies
The included systematic review was critically appraised by one reviewer using AMSTAR II, the non-randomized study was assessed using the ROBINS-I Tool, and guidelines, were assessed with the AGREE II instrument. Summary scores were not calculated for the included studies rather, a review of the strengths and limitations of each included study were described narratively.
Using Antibiotics To Treat Lyme Disease
Lyme disease is typically treated with antibiotics, although the type of antibiotic used depends on what stage of the disease you have.
After you remove a deer tick that has been attached to you for at least 36 hours the amount of time it takes for the tick to transmit the bacteria Borrelia burgdorferi theres a 72-hour window during which your doctor may give you a single dose of the antibiotic doxycycline to prevent the development of Lyme disease.
Doxycycline is prescribed to patients age 8 and older, except for pregnant women. Not everyone in this situation will receive doxycycline the deer tick bite needs to have occurred in a highly endemic area .
If you have localized Lyme disease with the telltale bulls-eye rash, also known as erythema migrans, but no other significant symptoms, your doctor will most likely treat you with oral doxycycline, amoxicillin, or cefuroxime for 10 to 14 days. If you have early disseminated Lyme disease, which may include the characteristic rash along with cardiac or neurologic symptoms, the treatment duration is lengthened to 14 to 21 days.
But if you have severe neurologic disease, such as meningitis, encephalitis, or nerve issues, or serious cardiac symptoms, your treatment will require taking intravenous ceftriaxone for 14 days.
Late disseminated Lyme disease is also treated with various antibiotics:
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Tick Check And Tick Removal
In most cases, ticks begin transmitting the Lyme disease spirochete only after 36 to 48 hours of attachment, however the precise minimum time is not known. Removing a tick within 24 to 48 hours can reduce your chance of contracting Lyme disease. The following tips are important for self-inspection:
- Nymph ticks are very small and may resemble poppy seeds, freckles, or scabs. Adult ticks may resemble raisins.
- People spending time in tick-infested locations should inspect themselves several times a day, including at bedtime.
- Check non-exposed areas, such as the back of the knee, as well as exposed areas. Someone else should check the scalp, back of the neck, and other difficult to reach areas. Parents should check children.
- After coming from outdoors, take a shower. It may help wash off unattached ticks, gives you an opportunity for a complete tick check, and will remove any remaining DEET.
- Check clothing as well as skin. A tick on clothes can be hidden in folds or creases.
If an attached tick is discovered, there is no reason to panic. A very small percentage of ticks are actually infected , and not everyone who is bitten by a tick will get Lyme disease.
Do not put a hot match to the tick or try to smother it with petroleum jelly, nail polish, or other substances. This only prolongs exposure time and may cause the tick to eject the Lyme spirochete into the body.
The following is the safest and most effective way to remove an attached tick:
Lyme Disease Antibiotic Treatment Research
For early Lyme disease, a short course of oral antibiotics, such as doxycycline or amoxicillin, cures the majority of cases. In more complicated cases, Lyme disease can usually be successfully treated with three to four weeks of antibiotic therapy.
After being treated for Lyme disease, a minority of patients may still report non-specific symptoms, including persistent pain, joint and muscle aches, fatigue, impaired cognitive function, or unexplained numbness. These patients often show no evidence of active infection and may be diagnosed with post-treatment Lyme disease syndrome .
Multiple clinical trials, funded by NIH and others, have shown no benefit to additional IV antibiotic treatment in patients with Lyme disease, although the interpretation of those results have been challenged by some.
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Guidelines With Unclear Methodology
- CHEO. Prophylaxis of Lyme disease in pediatric patients. 2018.
- MukkadaS, BuckinghamSC. Recognition of and prompt treatment for tick-borne infections in children. Infect Dis Clin North Am. 2015 29:539555.
- OnyettH. Lyme disease in Canada: focus on children. Paediatr Child Health. 2014 19:379388.
- SmithGN, GemmillI, MooreKM. Management of tick bites and lyme disease during pregnancy. J Obstet Gynaecol Can. 2012 34:10871091.
- SzulzykT, FlisiakR. Lyme borreliosis. Ann Parasitol. 2012 58:6369.
- LopezSMC, CampfieldBT, NowalkAJ. Oral management for pediatric Lyme meningitis. J Pediatric Infect Dis Soc. 2018.