Suggest Antibiotics To Treat Lyme Disease

Posted on Thu, 7 Sep 2017

Question: What is the best oral antibiotic for lyme disease that has effected the nervous system?

Answered by Dr. Lekshmi Rita Venugopal (1 hour later)

Brief Answer:
Antibiotics for Lyme disease

Detailed Answer:
Hello,
Thank you for trusting HCM

Antibiotics of choice depends on what part of nervous system is affected ie, whether brain/spinal cord/meninges or peripheral nerves are affected
For Lyme disease affecting peripheral nerves like Bell's palsy treatment is with oral Doxycycline for 21 days.

In case of Lyme meningitis, initiation of intravenous antibiotics is required.The drug of choice is ceftriaxone (2 g/day for 14 days).

Hope this answers your questions
Please address further questions here
Regards
Dr.Lekshmi

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Lekshmi Rita Venugopal (15 hours later)

What are the risks with ceftriaxone? Also would the intramuscular injections be effective as opposed to IV?

I am also being told that doxycycline can cause intracranial hypertension and blindness.

?

Answered by Dr. Lekshmi Rita Venugopal (4 hours later)

Brief Answer:
Follow up answer

Detailed Answer:
Hello again,

Doxycycline can cause intracranial hypertension and visual disturbances. But the occurrence of such side effects are very rare and the timely discontinuation of doxycycline usually reverses the situation.If you are too worried about the side effects of doxycycline, oral amoxicillin and cefuroxime are safe alternatives.

Side effects of ceftriaxone- Pain at injection site, allergic reaction, liver and kidney problems, Diarrhea and colitis, increased bleeding risk in people who are vitamin K deficient etc.

IM ceftriaxone is not preferred in the treatment of meningitis. This is because during IM administration the medication will not attain enough plasma concentration to cross the blood brain barrier and reach the brain to fight off the infection. So IV administration is the preferred choice for treatment of meningitis.

Hope this answers your questions
Please address further questions here
Regards
Dr.Lekshmi

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Lekshmi Rita Venugopal (2 days later)

I don't have menningtis but I have cranial nerve involvement.

I am not sure what to take.

Would high dose amoxicillin cross the blood brain barrier or do I need something like doxy?

Also I wanted to know if it's true that you can only develop CDIFF from antibiotics, only if you have c diff in you already? correct?

Answered by Dr. Lekshmi Rita Venugopal (4 hours later)

Brief Answer:
Follow up answer

Detailed Answer:
Hello again,

Cranial nerve involvement can be treated with oral antibiotics. Intravenous antibiotics are not needed. If you are too worried about side effects of doxycycline, Amoxicillin is also a good choice. Oral Amoxicillin 500 mg thrice daily for 20-30 days (depending on the resolution of symptoms) can be used in managing Lyme involving cranial nerves.

Broad spectrum antibiotics like Amoxicillin has potential to cause C.difficle infection in anybody. C.Difficle necessarily does not need to be in your system.Antibiotics can disrupt the normal intestinal flora thereby making you more prone to C.Difficle infection. Another possibility is that underlying C.difficle even in small numbers can become activated with the disruption of normal flora.

Hope this answers your questions
Please address further questions here
Regards
Dr.Lekshmi

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Above answer was peer-reviewed by : Dr. Raju A.T