Therapy goals
- Elimination of the pathogens
- Avoidance of complications
Therapy recommendations
- General antibiosis (antibiotic therapy) after tick bite is not recommended. The exception is multiple bites in a high-risk area.
- Antibiotic therapy (doxycycline, penicillin G, ceftriaxone or cefotaxime as monotherapy):
- In erythema migrans (wandering redness) immediately without antibody detection, lymphocytoma: doxycycline; in pregnant women with amoxicillin or cefuroxime axetil.
- For complications (neuroborreliosis (infestation of brain and nerve tracts), carditis (inflammation of the heart); arthritis (inflammation of joints); acrodermatitis chronica atrophicans/inflammatory skin disease of the ends of the body with skin atrophy (thinning of the skin) and livider (bluish) discoloration; predilection sites: Dorsum of hands and feet, elbows, and knees: differential diagnoses: chronic venous insufficiency, arterial occlusive disease, senile atrophy of the skin), antibiotic therapy (doxycycline, penicillin G, ceftriaxone, or cefotaxime as monotherapy) of up to 21 days is required
- Neuroborreliosis (doxycycline and beta-lactam antibiotics (penicillin G, ceftriaxone (antibiotic of choice), and cefotaxime)): Duration of therapy: early neuroborreliosis: 14 days; late neuroborreliosis 14-21 days.
- Notes on asymptomatic infection (“without apparent symptoms”):
- Complaint-free patients are not in need of therapy regardless of the serological findings!
- Exception: pregnant women and persons with increasing IgM antibody concentrations.
- After successful therapy, elevated antibodies (AK) may still be detectable for months to years (“serum scar”). Likewise, IgM persistence (persistence) is possible over one to three years with successful therapy.
- In case of strong IgM increase and persistent and recurrent symptoms, a renewed antibiotic therapy is indicated.
- A vaccine for Europe must have three human pathogenic species: B. afzelii, B. garinii, and B. burgdorferi sensu stricto. A trivalent vaccine (3 OspA species) for Europe is in the trial phase.
- See also under “Further therapy”.
Notice: Wg. Post-Lyme syndrome: patients did not fare better after 14 weeks of antibiotic treatment than after a 12-week cycle of therapy.
Notes on Lyme carditis
