- New Drugs Could Help Combat Chronic Lyme Disease
- Stages of Lyme Disease
- Topic Overview
People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime axetil. People with certain neurological or cardiac forms of illness may require intravenous treatment with antibiotics such as ceftriaxone or penicillin.
Treatment regimens listed in the following table are for localized (early) Lyme disease. See references below (Hu 2016; Sanchez 2016) for treatment of patients with disseminated (late) Lyme disease. These regimens are guidelines only and may need to be adjusted depending on a person’s age, medical history, underlying health conditions, pregnancy status, or allergies.
|Age Category||Drug||Dosage||Maximum||Duration, Days|
|Adults||Doxycycline||100 mg, twice per day orally||N/A||10-21*|
|Cefuroxime axetil||500 mg, twice per day orally||N/A||14-21|
|Amoxicillin||500 mg, three times per day orally||N/A||14-21|
|Children||Amoxicillin||50 mg/kg per day orally, divided into 3 doses||500 mg per dose||14-21|
|Doxycycline||4.4 mg/kg per day orally, divided into 2 doses||100 mg per dose||10-21*|
|Cefuroxime axetil||30 mg/kg per day orally, divided into 2 doses||500 mg per dose||14-21|
*Recent publications suggest the efficacy of shorter courses of treatment for early Lyme disease.
NOTE: For people intolerant of amoxicillin, doxycycline, and cefuroxime axetil, the macrolides azithromycin, clarithromycin, or erythromycin may be used, although they have a lower efficacy. People treated with macrolides should be closely monitored to ensure that symptoms resolve
The National Institutes of Health (NIH) has funded several studies on the treatment of Lyme disease that show most people recover when treated within a few weeks of antibiotics taken by mouth. In a small percentage of cases, symptoms such as fatigue (being tired) and muscle aches can last for more than 6 months. This condition is known as “Post-treatment Lyme Disease Syndrome” (PTLDS), although it is often called “chronic Lyme disease.” For details on research into “chronic Lyme disease” and long-term treatment trials sponsored by NIH, visit the visit the National Institutes of Health Lyme Disease web siteexternal icon.
New Drugs Could Help Combat Chronic Lyme Disease
Researchers have identified US Food and Drug Administration (FDA)-approved drugs that could help in the fight against post-treatment Lyme disease syndrome (PTLDS).
Venkata Raveendra Pothineni, PhD, at the Stanford University School of Medicine in Stanford, California, and colleagues published the results of their study in the journal Drug Design, Development and Therapy.
“his study has provided a mean to screen a large number of compounds using a highly sensitive, reliable, and rapid platform. The assay has identified a number of FDA-approved drug molecules with their potential to be repurposed for use against both Lyme disease and the associated PTLDS,” the authors write.
Lyme disease—caused by the spirochete Borrelia burgdorferi predominantly—is the most common zoonotic bacterial disease in North America, with an estimated 300,000 or more cases reported annually in the United States alone.
In most patients, antibiotic treatment will completely cure Lyme disease. However, even after appropriate antibiotic treatment, up to 20% of patients with Lyme disease experience long-lasting symptoms, such as muscle and joint pain, fatigue, and problems with memory or concentration. This condition is categorized as PTLDS.
The reason why these symptoms recur in some individuals remains unknown. However, according to the authors, “ome researchers have raised the question that Borrelia may persist in some hosts after antibiotic treatment, but the idea is controversial.”
New drugs that can completely eliminate the causative Borrelia organisms are therefore needed. “In an effort to search for the lead molecules that can potentially be used for clinical application, we developed and used a faster, efficient, and reliable HTS platform for the screening of drug molecules against Borrelia,” the authors write.
In their study, Dr. Pothineni and colleagues tested more than 4,000 drug compounds in the lab for their efficacy against B. burgdorferi. Ultimately, based on the results of their study, they selected the top 20 FDA-approved drugs. They found that these drugs prevented the growth of between 95% and 99.8% of the bacteria in the samples.
Among the identified drugs, the antibiotics erythromycin (which is already used clinically for the treatment of Lyme disease) and kitasamycin seemed to be very active. Anthracycline-based antitumor antibiotics—including epirubicin, doxorubicin, and idarubicin—also significantly blocked bacterial growth. Currently, these drugs are mostly used in the treatment of certain cancers. Of particular interest, disulfiram—an alcohol dehydrogenase inhibitor—was also identified as a potential drug candidate. This drug is primarily used in the treatment of alcohol abuse, although it also has anticancer properties.
The authors emphasized that “he identified compounds can be further investigated for their therapeutic potential in preclinical animal models and in patients with Lyme disease.”
“Moreover, due to the broad variety of molecules, multiple routes of administration and dosage forms can be developed for effectively treating the Lyme disease infections,’ the authors conclude.
Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals, and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee. To stay informed on the latest in infectious disease news and developments, please sign up for our weekly newsletter.
Stages of Lyme Disease
Lyme disease can go through several stages. It may cause different symptoms, depending on how long you have been infected and where in your body the infection has spread.
Stage 1: Early localized Lyme disease (1 to 4 weeks)
Early localized Lyme disease develops days to weeks after you become infected. You may have:
- An expanding, circular red rash (erythema migrans).
- Flu-like symptoms, with or without the rash. The symptoms include:
- Lack of energy.
- Headache and stiff neck.
- Fever and chills.
- Muscle and joint pain.
- Swollen lymph nodes.
In some cases of Lyme disease, the person doesn’t notice any symptoms during this stage.
Stage 2: Early disseminated infection (1 to 4 months)
If Lyme disease isn’t found and treated while early symptoms are present, or if you don’t have early symptoms that trigger the need for treatment, the infection may affect the skin, joints, nervous system, and heart within weeks to months after the initial infection.
Symptoms may include:
- An expanding, circular rash at the site of the bite. More rashes may appear on other parts of your body as the infection spreads.
- Pain, weakness, or numbness in the arms or legs.
- Not being able to use the muscles of the face.
- Headaches or fainting that continues to happen.
- Poor memory and reduced ability to concentrate.
- Conjunctivitis (pinkeye) or sometimes damage to deep tissue in the eyes.
- Brief episodes of pain, redness, and swelling in one or more large joints—most often the knee. Joint problems are common.
- Occasional rapid heartbeats (palpitations) or, in rare cases, serious heart problems.
Late persistent Lyme disease
If Lyme disease isn’t promptly or effectively treated, damage to the joints, nerves, and brain may develop months or years after you become infected. It is the last and often the most serious stage of the disease.
Symptoms at this stage may include:
- Arthritis that most often affects the knee. A small number of people eventually get chronic Lyme arthritis, which causes recurring episodes of swelling, redness, and fluid buildup in one or more joints that last up to 6 months at a time.
- Numbness and tingling in the hands, feet, or back.
- Feeling very tired.
- Not being able to control the muscles of the face.
- Problems with memory, mood, or sleep, and sometimes problems speaking.
- Heart problems, which are rare but can occur months to even years after you are bitten by an infected tick. The most serious heart problems—such as inflammation of the structures surrounding the heart (pericarditis)—usually resolve without any lifelong damage. Unfortunately, heart problems can be the first sign of Lyme disease in a small number of people who didn’t have early symptoms.
Stage 2 and stage 3 symptoms may be the first signs of Lyme disease in people who didn’t have a rash or other symptoms of early infection.
If you don’t notice the tiny deer tick bite on your body, it can be easy to dismiss signs of Lyme disease. You may suspect flu and give it a week or so, thinking it will resolve on its own. But by then, the bacterial infection has had time to spread.
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“The human body reacts the same way to many different things,” says primary care physician Daniel Sullivan, MD. “If you get the flu, you get a low-grade fever, develop muscle aches and feel a little off, and if you are infected with the Lyme bacteria you can feel the same way.”
These types of symptoms might warrant someone considering getting medical attention, but not necessarily right away, he says.
How does Lyme disease work?
The bacterium Borrelia burgdorferi causes Lyme disease when it get into your bloodstream. You may experience a variety of symptoms, depending on the stage of infection.
Early on, typical symptoms of Lyme disease include fever, chills, headache, joint aches and – most distinctively – a spreading rash that resembles a bulls-eye.
But if it isn’t identified and treated within 36 to 48 hours, the infection can spread to other parts of your body, including the heart and nervous system.
The later, more serious stages of Lyme disease can lead to neurological damage and arthritis.
Treating Lyme disease
Most people notice the bulls-eye rash and seek treatment immediately. And, most often, that’s the end of the story, Dr. Sullivan says.
“During the early stages of Lyme disease, oral antibiotics treat the infection and most patients will recover quickly and completely,” he says. “If that rash is not noticed, it can then go on to other manifestations that can affect the muscles, joints, heart and nerves.”
Whether your doctor identifies the disease in early stages or late, the first step is to treat the infection with antibiotics.
“In most cases, where it is more distant and has spread, once the infection is treated, the inflammation and the irritation to the nerves, heart and joints will slowly resolve over time,” Dr. Sullivan explains.
Patients often ask whether a longer course of antibiotics would help speed healing, he notes. “Most patients are on antibiotics from 10 days to two weeks — if it affected the heart or spinal fluid, it’s four weeks,” he says.
While some patient advocacy sites call for longer therapy lasting up to six months, there is no evidence for going beyond four weeks, he says. “Within four weeks, the antibiotics will kill the bacteria. A longer course of antibiotics could potentially cause more harm than good.”
Living with Lyme disease
Once antibiotics resolve the infection, you can support your recovery from Lyme disease as you would with any kind of arthritis or nerve injury. It is recommended that you:
- Eat a healthy diet and limit your sugar intake.
- Get plenty of rest.
- Exercise at least three times a week for at least 30 minutes each day.
- Reduce stress.
- Use anti-inflammatory medication when necessary.
“The damage Lyme disease causes to your nerves or muscles would heal over a course of months,” Dr. Sullivan says. “Identifying the infection and treating it appropriately so that the infection is cleared is the first step. And then the body can start to heal.”