Fast Five Quiz: Lyme Disease Practice Essentials

Herbert S. Diamond, MD


February 25, 2021

Early localized Lyme disease refers to isolated erythema migrans and to an undifferentiated febrile illness. This stage occurs 1-30 days after the tick bite. In endemic areas, patients with erythema migrans and a recent history of possible or proven tick exposure can be treated empirically, without laboratory confirmation of the diagnosis.

Antibiotic selection, route of administration, and duration of therapy for Lyme disease is decided on the basis of the patient’s clinical manifestations and stage of disease, as well as the presence of any concomitant medical conditions or allergies. Prompt treatment increases the likelihood of therapeutic success. With quick and appropriate antibiotic treatment, most patients with early-stage Lyme disease recover rapidly and completely.

According to the CDC, adults with erythema migrans should receive doxycycline (100 mg, twice per day orally) for 10-14 days, amoxicillin (500 mg, three times per day orally) for 14 days, or cefuroxime (500 mg, twice per day orally) for 14 days.

In patients without neurologic disease, Lyme arthritis can usually be treated successfully with oral antibiotics, with an extended treatment time of 28 days. Recommended regimen for adult patients is as follows:

  • Doxycycline, 100 mg twice daily

  • Amoxicillin, 500 mg three times daily

  • Cefuroxime axetil, 500 mg twice daily

Intra-articular corticosteroids should not be given before antibiotic treatment, as they may promote persistent Lyme arthritis. They are rarely indicated after antibiotic treatment.

Adult patients with Lyme meningitis or radiculoneuritis should receive doxycycline (200 mg per day orally, divided into 1-2 doses) for 12-21 days or ceftriaxone (2 g intravenously, once a day or orally once patient is stabilized/discharged) for 14-21 days.

Read more about the treatment of Lyme disease.

This Fast Five Quiz was excerpted and adapted from the Medscape Drugs & Diseases article Lyme Disease.

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