How Is Lyme Disease Treated?

Medically reviewed by Soma Mandal, MD

Lyme disease is the most common tick-borne illness (spread by infected ticks) in the United States. A bacterial infection known as Borrelia burgdorferi causes Lyme disease. Antibiotics clear bacterial infections, especially in the early stages. However, Lyme disease can progress if left untreated.

Primary care providers and infectious disease specialists typically treat Lyme disease. But, if your infection progresses to later stages, your healthcare provider may refer you to a rheumatologist (a medical doctor who specializes in autoimmune and musculoskeletal conditions) for joint problems or a neurologist (a medical doctor who specializes in the brain and spinal cord) if you have symptoms that affect your brain or nerve issues.

Treatments Based on Lyme Disease Stage

Lyme disease is a bacterial infection of deer ticks that can transmit to humans. There are three stages of this condition, including:

• Stage 1: Early localized

• Stage 2: Early disseminated

• Stage 3: Late disseminated

Antibiotics are the first line of treatment for Lyme disease, as they stop the infection from spreading by killing harmful bacteria. Treating Lyme disease early prevents the infection from spreading to your joints, nervous system, and heart. How long you take antibiotics and the method you use to take them depends on the stage of the disease and the symptoms you are experiencing.

Treatments for Early Localized Lyme Disease

Symptoms of early localized Lyme disease typically include a low-grade fever and a rash. About 70-80% of people with Lyme disease get an erythema migrans (EM) rash. An EM rash is an oval or circular-shaped rash that can itch, burn, and expand over time. EM rashes can appear within 1-28 days after a tick bite and last up to three weeks.

People with early localized Lyme disease often require a 10-14-day course of oral (by mouth) antibiotics. Common antibiotics include:

• Vibramycin (doxycycline)

• Doryx (doxycycline)

• Adoxa (doxycycline)

• Amoxil (amoxicillin)

• Trimox (amoxicillin)

• Ceftin (cefuroxime)

• Zinacef (cefuroxime)

• Kefurox (cefuroxime)

Doxycycline is the most common antibiotic for everyone except children under eight years old and pregnant people. Children under eight may get amoxicillin to prevent tooth staining that may occur with doxycycline. Pregnant people typically get cefuroxime to avoid tooth discoloration or bone problems for the baby. Recent studies suggest that doxycycline does not stain teeth, but providers may still recommend doxycycline if other antibiotics don't work.

If you can't take doxycycline, amoxicillin, or cefuroxime to treat an EM rash, your provider might give you Zithromax, also known as Z-Pac (azithromycin). Zithromax isn’t as effective as other antibiotics, so your provider may not prescribe this medication first. If you receive Zithromax, your provider will likely monitor your treatment journey and symptoms closely.

While effective, antibiotics may cause some side effects like:

• Diarrhea

• Allergic reactions

• Yeast infections (irritation or itching in the vaginal area)

When you start treatment for Lyme disease, you might also have a Jarisch-Herxheimer reaction—a temporary response to antibiotics killing the bacteria. This reaction can cause symptoms like fever, chills, and malaise (a general unwell feeling). Symptoms typically resolve in a day.

Treatments for Early Disseminated Lyme Disease

In early disseminated Lyme disease, symptoms spread through the body about 3-12 weeks after the initial infection. Symptoms may include:

• Fever

• Fatigue

• Headache

• Dizziness

• Joint or muscle pain

• Swollen glands

• Vision problems

• Heart palpitations

• Chest pain

• Neurological (brain, spinal cord, and nerve) symptoms like loss of muscle movement in the face

For stage 2 Lyme disease, you’ll likely need to take antibiotics for a longer period. Treatment may last for 2-4 weeks. If you have severe nerve or heart problems, can’t take oral antibiotics, or if oral antibiotics are not working for you, your provider may offer you intravenous (IV) antibiotics that you can receive through a vein in your arm.

Treatments for Late Disseminated Lyme Disease

Late disseminated Lyme disease symptoms can appear weeks to months after the initial infection. At this stage, harmful bacteria can spread to other parts of your body, causing symptoms like:

• Knee pain

• Trouble walking

• Difficulty concentrating

• Seizures

• Sharp or shooting nerve pain

• Thinning skin

• Bell's palsy (a condition that causes the inability to move one side of your face)

• Irregular heartbeat

At this stage of Lyme disease, your provider will likely prescribe antibiotics for four weeks to several months. Severe symptoms will often require intravenous (IV) antibiotics.

If your condition is causing vision problems (such as eye pain or swelling), you may need steroids to reduce swelling. On the other hand, if Lyme disease is causing heart problems, you may need immediate medical attention or have to wear a heart monitor at home until symptoms improve.

Medications for Symptom Relief

In addition to prescription antibiotics, your provider might suggest over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen), Motrin (ibuprofen), or Aleve (naproxen) to help relieve joint pain and inflammation (swelling).

Home Remedies

Treatment helps your body fight the infection but doesn't make you immune forever. You can get Lyme disease again if another infected tick bites you. To stay safe, know where ticks are and take steps to avoid reinfection.

Ticks like to live in grassy, wooded areas, especially in the warmer months. When you’re outside, avoid tall grass, and stick to designated walking or hiking trails. Taking care of your yard is also an important way to avoid coming into contact with ticks. Consider the following strategies:

• Spray a repellent in your yard to ward off ticks

• Use acaricides (chemicals that reduce tick populations in outdoor areas)

• Place tick tubes in your yard to keep ticks away

• Consider getting professional pest control if your yard has a tick infestation

Next time you’re on a walk or hike outside, following these prevention strategies can also reduce your risk of getting a tick bite:

• Wear long, light-colored clothes

• Spray insect repellent on your clothing

• Have permethrin-treated clothing or gear for protection against ticks

• Carry a tick control medication to keep your pets safe

It’s also a good idea to check for potential tick bites before you return home. Here’s a checklist of things to do after a walk or hike:

• Check for ticks on yourself, family, and pets

• Remove ticks with tweezers

• Put clothes in the dryer on high heat for 10 minutes to kill ticks

• Shower within two hours of coming indoors to wash off unattached ticks

Finding a Repellent

The Environmental Protection Agency (EPA) search tool can help you find an effective repellant.

Living With and Managing Lyme Disease

While it’s rare, some people with Lyme disease may experience persistent symptoms despite treatment. About 5% of people feel tired, achy, or have joint pain even after treatment. This can last for six months or more and may require other pain management treatments until symptoms improve.

If you live with Lyme disease, strategies like pacing your activities to conserve energy and modifying work or living environments can improve your daily life and reduce fatigue. You might also consider massages to help relieve muscle pain, tension, and stress. Probiotics can also help fight the side effects of antibiotics (like yeast infection or diarrhea). Before starting any at-home remedies to manage symptoms, it’s always important to talk to your healthcare provider to learn what’s safe for you.

A Quick Review

If you have Lyme disease, getting started on treatment sooner and following your treatment plan as directed can reduce your risk of complications. Your exact treatment plan will depend on the stage and severity of your symptoms.

Common treatments for this condition often involve antibiotics to eliminate harmful bacteria. At-home remedies and OTC medications can also help keep symptoms at bay.

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