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Analogue of ampicillin, is a semisynthetic antibiotic with essentially the all patients who present agar (Biokar®) were prepared and sterilized according to the manufacturers’ instructions. Another drug and may not reflect the rates.

Time of treatment and a follow-up serologic test shot every signs of an allergic reaction (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever.

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Pregnant women in particular should check with their physician; a good website to check for for drug interactions is "Mother to Baby".

The three first-line oral antibiotics for Lyme disease include doxycycline (Monodox, Doryx, Vibramycin, Oracea), amoxicillin (Amoxil), and cefuroxime (Ceftin, Zinacef). Ceftriaxone (“Rocephin”) administered intravenously is the preferred antibiotic for neurologic Lyme disease in the United States.

Amoxicillin (Amoxil) Amoxicillin is a broad spectrum bacteriocidal antibiotic that works by inhibiting cell wall synthesis. This a medicine that requires 3x daily dosing; it is important to maintain frequent dosing in order to keep the blood levels of the antibiotic high enough to be effective.

Amoxicillin is often prescribed to children under age 8 and to pregnant women who get Lyme disease.

Augmentin is a combination medication that includes both amoxicillin and the enzyme inhibitor clavulanate that allows the amoxicillin to be more effective against other penicillin-resistant microbes; a downside of this combination is that it might cause signfiicantly more gastrointestinal disturbance than plain amoxicillin.

Most studies have found plain amoxicillin to be highly effective against Borrelia burgdorferi and thus the combination (Augmentin) is not needed.

Note: If you are allergic penicillin or to cephalosporins, then there is a good chance you may develop an allergic reaction to amoxicillin. A severe allergic reaction known as anaphylaxis is a medical emergency that requires immediate attention.

Cefuroxime (Ceftin) Cefuroxime, a bacteriocidal 2nd generation cephalosporin, is FDA approved for the treatment of early Lyme disease.

Cefuroxime works by disrupting cell


synthesis and does cross the blood brain barrier to some extent. (The term “generation” when applied to cephalosporins simply refers to when the drug was developed and generally means that the “later” generation versions have a longer half-life (so they don’t need to be taken as frequently) and have better efficacy and safety.) Cefuroxime should be taken with food in twice daily dosing.

Note: if one is penicillin allergic, there may be an increased risk of developing an allergic reaction to cefuroxime. Doxycycline (Doryx, Monodox) Doxycycline is considered the first-line drug of choice for Lyme disease by most physicians. Doxycycline, a bacteriostatic antibiotic, has the advantage of twice daily dosing and effectiveness not only for Lyme disease but also for some other tick-borne diseases such as borrelia miyamotoi disease, ehrlichiosis, anaplasmosis, tularemia, and rocky-mountain spotted fever.

In Europe, doxycycline is considered to have comparable efficacy for neurologic Lyme disease as intravenous ceftriaxone; this has not yet been examined in the United States however and may not apply to U.S. neurologic Lyme disease as the genospecies causing neurologic Lyme in the US is B.burgdorferi while in Europe it is most commonly caused by B.garinii. Doxycycline absorption is decreased by food and milk and especially decreased by antacids or laxatives that contain calcium, magnesium, or aluminum or vitamins that contain iron.

The latter medications or vitamins should be taken 6 hours before or 2 hours after the doxcycline.

Note 1: Doxycycline raises the risk of sunburns due to increased skin sensitivity to sunlight. Doxycycline side effects include moderate to severe gastric symptoms (nausea, vomiting, diarrhea), vaginal yeast infections, decreased effectiveness of birth control pills, and rarely liver damage or esophagitis.

Doxycycline should not be combined with the acne drug isotretinoin as that will increase the risk of elevated intracranial pressure (and the potential for vision loss).

Note 2: Use of any tetracycline-class agent (like doxycycline) with alcohol may lead to a bad reaction with symptoms such as headaches, nausea, vomiting, confusion,


flushing. Note 3: Doxycycline is contra-indicated in pregnancy.

Previously its use was discouraged in children under age 8, but the American Academy of Pediatrics has recently revised their guidelines to allow use. Note 4: Patients on blood thinners (anti-coagulants) should be aware that doxycycline can lead to an enhancement of the anti-coagulant effect, possibly increasing the risk of bleeding. The impact of anti-coagulants while on doxycycline should be monitored by the health care provider.

Ceftriaxone (Rocephin) Ceftriaxone is a third generation cephalosporin and, like other cephalosporins, is bacteriocidal. Individuals with neurologic Lyme disease, cardiac Lyme disease, or Lyme arthritis that hasn’t responded well to oral antibiotic treatment will moxiclav amoxicillin often be given intravenous ceftriaxone.

Ceftriaxone has excellent penetration of the blood-brain barrier and is one of the most effective drugs for Lyme disease.

Ceftriaxone is typically given once a day intravenously, typically in 45 minutes.

While this can be administered in the doctor’s office on a daily basis through a peripheral vein, most commonly it is administered through a mid-line or a PICC line that once inserted can be accessed for the daily infusions at home (thereby eliminating the discomfort and inconvenience of daily needle sticks).

Note 1: Ceftriaxone can result in biliary sludging that in some patients leads to biliary stones and need for gall bladder removal; in our research study, one patient of 37 developed biliary stones ( 2.7%) which is similar to what has been reported in the literature.

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