The optimal treatment regimes for EM rashes and disseminated Lyme disease have not yet been determined. Some protocols advocate limited courses of antibiotic treatment. Others consider that persistent symptoms are the result of persistent infection and require individualised treatment regimes. Many doctors and patients report benefit from combined and extended antibiotic treatment regimes.

Tick bites in asymptomatic patients

Prophylactic antibiotic treatment is not routinely recommended. However, there may be some circumstances where specialist opinion would support the idea of a two-week course of antibiotics at treatment level dosages. For example, prolonged tick attachment in a Lyme endemic area, multiple concurrent tick bites, immunosuppression. The evidence for a single dose of doxycycline 200mg is disputed and is not recommended. Patients should be made aware of the signs and symptoms of Lyme disease and advised to seek medical help if required.

Treatment guidelines for Lyme disease

NICE recommends specific antibiotic regimes for adults and children. The guideline committee acknowledged the limited evidence upon which their recommendations were based and made research recommendations.

Jarisch-Herxheimer reaction

Be aware of the possibility of a Jarisch-Herxheimer reaction. This is a systemic reaction thought to be caused by the release of cytokines when antibiotics kill large numbers of bacteria. Symptoms may include a worsening of fever, chills, muscle pains and headache. The reaction may start soon after starting antibiotics but can also occur slightly later and may last for a few hours or several days. It is self-limiting and resolves spontaneously.