Treatment Options

In this section we provide tips on the usage of various standard antibiotics for Lyme disease as well as less standard ones. We also review other treatment approaches for pain, fatigue, insomnia, and memory and mood issues. Our comments here are by no means comprehensive. We refer the reader to other sources that describe why patients might have persistent symptoms and other treatment options (e.g., in portions of our book Conquering Lyme Disease: Science Bridges the Great Divide(link is external and opens in a new window)). Here we simply wish to provide some important facts that people should know about various treatments.

Doctors are taught in medical school: "Above all do no harm". However, nearly all treatments have both benefits and risks. Therefore prior to any thereapeutic intervention (e.g, medicinal, herbal, diet change, even exercise), individuals need to review how this intervention might impact them. When considering treatment options for Lyme disease, patients should find out how well studied these treatments are, whether they have been shown to be effective, and what the side effects are. Patients should also keep an open mind regarding what might help, as some symptoms may reflect active infection (and therefore benefit from antibiotics) while others may reflect the residual effects on the body of the prior infection (and therefore require non-antibiotic approaches). The goal is to restore one's health and functional status so as to maximize quality of life.

As with all recommendations on this website, the taking of over-the-counter or prescribed medications should be carefully reviewed with a physician to ensure safety and efficacy and to assess for potentially harmful drug interactions. Pregnant women in particular should check with their physician; a good website to check for for drug interactions is "Mother to Baby"(link is external and opens in a new window).

Antibiotics

The three first-line oral antibiotics for Lyme disease include doxycycline (Monodox, Doryx, Vibramycin, Oracea), amoxicillin (Amoxil), and cefuroxime (Ceftin, Zinacef). Ceftriaxone (“Rocephin”) administered intravenously is the preferred antibiotic for neurologic Lyme disease in the United States.

Other Antibiotics

Non-Antibiotic Pharmacologic and Other Approaches

These approaches are considered for those patients who have persistent symptoms that have not abated or resolved after antibiotic therapy. When symptoms persist, it is very important to take a fresh look at the patient and determine whether other problems have emerged (possibly unrelated to Lyme disease) that may be causing the symptoms. For example, fatigue may be due to anemia or thyroid deficiencies. Numbness and tingling may be due to vitamin deficiency (B1, B6, B12), diabetes, carpal tunnel sydnrome, or autoimmune causes.

While infection with Borrelia burgdorferi itself can cause many of the symptoms below and thus require antibiotic treatment, these symptoms may also be triggered but not sustained by the prior infection; this may be due to residual inflammation, ongoing immune activation, tissue damage, or neurotransmitter/neural circuitry changes. In this situation, symptom-based therapies can be quite helpful. Because the suggestions listed below have not yet been studied in clinical trials of Lyme disease , these suggestions are based on evidence obtained from other disorders with similar clinical features. None of these treatments have been FDA-approved for the treatment of Lyme disease-related symptoms.