Lyme disease is treated with oral antibiotics, most commonly doxycycline, amoxicillin, or cefuroxime. The specific drug, dose, and duration depend on the stage of the disease and whether it has spread beyond the skin. Most people who start antibiotics early recover fully within weeks.
Preventing Lyme Disease After a Tick Bite
If you’ve found a blacklegged tick on your body and removed it within the past 72 hours, a single dose of doxycycline (200 mg for adults) can prevent Lyme disease from developing. This preventive approach is recommended when the tick was likely infected, meaning it was found in an area where Lyme is common and appeared engorged with blood rather than flat. A flat, unfed tick is unlikely to have transmitted the bacteria.
Children weighing under 45 kg receive a weight-based dose. The 72-hour window matters because Lyme bacteria need at least three days to establish an infection after a bite, so the antibiotic can stop the process before it starts.
Antibiotics for Early Lyme Disease
Early Lyme disease, the stage where the characteristic bull’s-eye rash appears, is treated with one of three oral antibiotics:
- Doxycycline: 100 mg twice daily for 10 to 14 days
- Amoxicillin: 500 mg three times daily for 14 days
- Cefuroxime: 500 mg twice daily for 14 days
Doxycycline has the shortest possible course at 10 days. All three are considered equally effective, and the 2020 joint guidelines from the Infectious Diseases Society of America, the American Academy of Neurology, and the American College of Rheumatology give them equally strong recommendations. If you can’t tolerate any of these three, azithromycin is an alternative, though it is less effective and requires closer monitoring to make sure symptoms clear.
Children follow the same drug options with weight-based dosing. However, children under 8 are typically given amoxicillin or cefuroxime rather than doxycycline.
Treatment for Lyme Arthritis
When Lyme disease reaches the joints, usually causing swelling in one or both knees weeks to months after the initial infection, the same three antibiotics are used but for a longer course: 28 days instead of 10 to 14. The drugs and doses stay the same. The extra time is needed because the bacteria can be harder to clear from joint tissue.
If your symptoms improve but don’t fully resolve after that first 28-day course, your doctor may recommend a second round of the same oral antibiotic or simply continue monitoring you, since inflammation can take time to settle even after the bacteria are gone. If there’s no improvement at all after the first course, intravenous ceftriaxone (given through an IV once daily for 14 to 28 days) becomes the preferred next step.
Treatment for Lyme Affecting the Heart or Nervous System
Lyme disease occasionally spreads to the heart (Lyme carditis) or the nervous system, causing symptoms like facial palsy, numbness, or meningitis. Treatment at this stage depends on severity.
If you have Lyme carditis but are well enough to be treated as an outpatient, oral antibiotics are generally sufficient. If you’re hospitalized because the heart involvement is more serious, treatment typically starts with intravenous ceftriaxone (2 g once daily) until you improve, then switches to oral antibiotics to finish the course. For Lyme meningitis, IV ceftriaxone is the standard approach. Other forms of neurological Lyme disease, like facial palsy without meningitis, can often be managed with oral doxycycline alone.
Tips for Taking Doxycycline
Since doxycycline is the most commonly prescribed option, a few practical details are worth knowing. It significantly increases your sensitivity to sunlight, so you’re more likely to sunburn while taking it. Wear sunscreen, a hat, or protective clothing if you’ll be outdoors.
Absorption is the other consideration. Dairy products, calcium supplements, iron supplements, and multivitamins all interfere with how well your body absorbs doxycycline. Take it on an empty stomach and avoid these products around the time of your dose. Amoxicillin and cefuroxime don’t carry these same restrictions, which is one reason your doctor might choose them instead.
How Long Recovery Takes
Most people with early Lyme disease feel better within days to weeks of starting antibiotics. Some experience lingering fatigue or joint aches for a few weeks after finishing treatment, but these symptoms typically resolve on their own. Prolonged antibiotic courses beyond what’s recommended have not been shown to speed up this process and carry risks of their own, including disrupting gut bacteria and promoting antibiotic resistance.
The earlier treatment begins, the faster and more complete the recovery tends to be. People treated during the rash stage almost always recover fully. Those treated at later stages, after the infection has reached joints, the heart, or the nervous system, also generally respond well to antibiotics, though recovery can take longer and a small percentage continue to experience symptoms for months afterward.