Treatment
Standard Antibiotic Treatment
Lyme disease is treated with antibiotics, and when treatment begins in the early stages, most patients recover fully and relatively quickly. The antibiotic chosen, the route of administration (oral or IV), and the duration all depend on the stage of disease and which organ systems are affected.
Early Lyme Disease (Stages 1 and 2)
For early localized Lyme disease — often presenting with the erythema migrans rash — the standard treatment is a 10–21 day course of oral antibiotics:
- Doxycycline (100 mg twice daily) — preferred first-line treatment for adults and children over 8. Also treats co-infections like anaplasmosis.
- Amoxicillin or cefuroxime axetil — alternatives for children under 8, pregnant women, and those who cannot tolerate doxycycline.
Why Doxycycline Is Preferred
Doxycycline is the antibiotic of choice partly because it also treats anaplasmosis and ehrlichiosis — tick-borne co-infections often acquired alongside Lyme. Take with food to reduce stomach upset, and avoid extended sun exposure during the course.
Later-Stage Lyme Disease
- Neurological Lyme (severe): Intravenous (IV) ceftriaxone for 14–28 days, or oral doxycycline in some cases
- Lyme Arthritis: 28-day course of oral doxycycline or amoxicillin. IV antibiotics may be used if arthritis does not respond to oral treatment.
- Lyme Carditis: Oral antibiotics for mild cases; IV antibiotics and cardiac monitoring for more severe cardiac involvement
Recovery Expectations
Most people treated in early stages begin to feel better within days to two weeks of starting antibiotics. Joint and muscle aches may linger longer. Complete the full antibiotic course even if you begin feeling better early — stopping too soon may allow the infection to persist.
When Symptoms Persist After Treatment
An estimated 10–20% of Lyme patients continue to experience symptoms — fatigue, pain, cognitive difficulties — after completing standard antibiotic therapy. This is sometimes called Post-Treatment Lyme Disease Syndrome (PTLDS). The causes are not fully understood and remain an active area of research. See our Persistent Symptoms page for more.