Rx amoxicillin

The goal is to restore one's health and functional status so as to maximize quality of life.

As with all recommendations on this website, the taking of over-the-counter or prescribed medications should be carefully reviewed with a physician to ensure safety and efficacy and to assess for potentially harmful drug interactions. 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 amoxicillin and bronchitis 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 wall synthesis and does amoxicillin mk 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 amoxicillin angina 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

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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, and 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 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.

Some doctors prescribe “Actigall” to dissolve biliary stone formation, especially if the patient is starting to complain of epigastric pain or nausea.

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Therefore, patients need to remember to flush their PICC or Mid-line daily, to keep the PICC line site clean, and to not engage in “jerky” arm movements, such as might occur when washing windows or playing tennis or golf.

IN the evaluation of the patient prior to insertion of a PICC line or a Mid-Line, the clinician order blood tests to determine if the patient is at higher risk of forming blood clots or inquire about one’s family history of blood clotting. Note 3: Rarely ceftriaxone can trigger hemolytic anemia and pancreatitis. Note 4: Cefotaxime (Clarforan) is also a 3rd generation intravenous antibiotic. While Cefotaxime is less likely to cause gallstones, it requires 3x daily dosing which for most patients is too difficult to maintain.

Given that it is essential for efficacy that the drug be administered every 8 hours, cefotaxmine is less commonly used than ceftriaxone.

Benzathine Penicillin (Bicillin-LA) Benzathine Penicillin is an intramuscular form of penicillin that has the advantage of being long-acting and allowing for consistently high blood and tissue levels of penicillin.

Early studies indicated that it was helpful for neurologic Lyme disease, but not nearly as effective as intravenous ceftriaxone (Rocephin).

The blood levels after benzathine penicillin are almost as high as after IV ceftriaxone.

Because of the intramuscular administration, the risk of gastrointestinal side effects and yeast infections are lower than with oral antibiotics. Note: In most individuals Bicillin is self-administered, often in the muscle of the buttocks.

A lidocaine-like anesthetic cream can be applied topoically30-60 minutes before to reduce the injection site pain. The downside to benzathine penicillin is that many people do not want to inject themselves. Because once injected, it can’t be removed, it is important to make sure the individual is not allergic to this medication before initiating treatment.

Azithromycin and clarithromycin are macrolide antibiotics that have been studied in amoxicillin and tooth infection humans for the treatment of Lyme disease. Both are better tolerated than the older macrolide antibiotic erythromycin in having fewer gastrointestinal side effects.