Acute Lyme is easy to treat. Chronic Lyme is very hard to treat. A new case with an observed tick bite, a rash and acute flu like symptoms is usually fairly easy to treat. A four to six week course of Doxycyline, Amoxicillin or Ceftin should be adequate. If the patients appears fairly sick combination therapy with Doxycyclin with Amoxicillin or a similar mix may be used. Patients who present with a severe, acute form of the disease are manged differently. Patients for example may have acute meningitis and or encephalopathy. Such patients require aggressive treatment with intravenous antibiotics. My primary concern is treatment of patients with more typical chronic Lyme disease.
Long courses of antibiotics are usually necessary. Let me by explain the major classes of antibiotics and their mechanisms of action. Antibiotics can be classified as those which are bacteriocidal, those which kill bacteria, and those which are bacteri0static, those which stop replication of the germs. The clinical significance of this point with regard to Lyme therapy is not clear. Medications can be given either intravenously, requiring the placement of catheter called a PIC line, or they may be given orally. The choice of route is determined by many factors.
Cell wall antibiotics. This group of medicines inhibits the ability of the germ to assemble its cell wall. They are considered bacteriocidal. These are highly active against spirochetes. This class of antibiotics is effective against intact spirochetes, not L-forms or cyst forms.
Drugs that kill the cell wall deficient L-forms works within the cytoplasm, or interior of the bacterial cells. Drugs in the tetracycaline and erthromycin family work by inhibiting protein synthesis in structures called ribosomes. Tetracycalines, like Doxycyline and Minocin are popular. Macrolide drugs, related to Erthromycin work by the same mechanisms. These drugs are frequently combined with Plaquenil which has been shown in clinical studies to enhance their effectiveness.
Anti-parasitic medicines have been shown to kill Lyme cysts. These include Flagy and Tindamax.
Quinolone antibiotics, especially Cipro have also have been used for Lyme.
Rifampin is occasionally used. It inhibits bacterial RNA synthesis.
Antibiotics for Lyme are usually in combination. Different meds seem to work best for individual patients. The reason for this is unknown. Trial and error may be the only way to decide which antibiotics are best for a given patient.