Antibiotic treatment: 

The most commonly prescribed treatment for Lyme disease is the antibiotic doxycyline, a long-acting tetracycline, especially when the patient presents the erythema migrans rash at the site of the tick bite (Ro et. al. 2004).  Doxycycline, in comparison to tetracycline, achieves greater concentration in tissues, is taken twice a day, and causes minor gastrointestinal upset (Steere, 1989).  The dosage varies, but a typical doxycycline treatment would be 100mg twice a day for 14-21 days.  Amoxicillin is given to pregnant women or children under age 8 (Ro et. al. 2004).  Cefuroxime axetil is recommended for people who are allergic to doxycyline or amoxicillin, and erythromycin is given to patients who are unable to take any of these (Steere, 2001). 

The effectiveness of antibiotic treatment typically depends on the severity of the initial infection as well as the amount of time that the disease was allowed to progress before treatment was given (Steere, 1989).  Generally, patients treated soon after infection and with the proper antibiotic dose respond the most effectively to antibiotics.  Despite the effectiveness of antibiotics, nearly 10% of Lyme disease patients respond poorly to multiple rounds of antibiotic treatment (Diterich and Hartung, 2001).

In patients who experience neurological abnormalities, intravenous penicillin is typically prescribed and found to be effective.  Ceftriaxone, which must only be administered once a day, is also used because it effectively crosses the blood-brain barrier to reach bacteria in the cerebrospinal fluid (Steere, 1989).  After antibiotic treatment, acute neuroborreliosis should subside within weeks, while chronic neuroborreliosis may take months to subside (Steere, 2001).
If antibiotics are not sufficient to stop Lyme arthritis, patients often receive anti-inflammatory drugs (Steere, 2001). 

Vaccine:

The creation of a vaccine against Lyme disease has focused on the outer surface proteins (Osp) of B. burgdorferi, especially OspA. A vaccine against Lyme disease, called LYMErix™, is now available in the United States (Diterich and Hartung, 2001).  The vaccine is recommended for people between the ages of 15 and 70 who live in areas with a high prevalence of Lyme disease or where Ixodes scapularis ticks are heavily populated.  The vaccine is not recommended otherwise (Steere, 2001).  This vaccine contains lapidated B. burgdorferi s.s. with recombinant OspA.  The body creates antibodies in response to this vaccine, and when these antibodies are ingested from human blood by a tick, the antibodies enter the tick gut, inactivating any B. burgdorferi present in the tick gut (Diterich and Hartung, 2001). 

The effectiveness of the vaccine is determined by overall strength of the antibody response to the vaccine.  A phase 3 trial of the LYMErix™ vaccine showed that it was 49% effective after two injections and 76% effective after three injections (Steere, 2001). The vaccine is only effective in the United States where the B. burgdorferi s.s. strain is found.  One problem with the vaccines is that the antibodies produced by humans in response to the vaccine are only effective against the spirochete within the tick gut when it expresses OspA; once the spirochete enters the human blood it expresses OspC and the antibodies are no longer effective (Diterich and Hartung, 2001).  The only side effects of the vaccine include mild to moderate local and system reactions that last approximately three days; the vaccine has not been reported to induce Lyme arthritis (Steere, 2001).

This page was created for an undergraduate Immunology course, Biology 307, at Davidson College in the Spring semester of 2007 under Dr. Sophia Sarafova (sasarafova@davidson.edu)

Please direct all comments and questions to Meredith Prasse (meprasse@davidson.edu)