What is the first-line treatment for Lyme disease in adults?

Doxycycline is the first-line treatment for Lyme disease in adults due to its effectiveness against the causative organism, Borrelia burgdorferi. This tetracycline antibiotic has good tissue penetration and is particularly effective for the early manifestations of Lyme disease, including erythema migrans and early neurologic involvement.

Additionally, doxycycline is not only effective for Lyme disease but also addresses potential co-infections that can occur, such as Anaplasma phagocytophilum. It is generally well-tolerated and can be administered orally, making it suitable for outpatient management of Lyme disease.

While amoxicillin is an alternative for treating Lyme disease, particularly in children or pregnant women, doxycycline remains the preferred choice in adults due to its broader coverage and efficacy. Other antibiotics listed are not typically used for Lyme disease; ciprofloxacin is primarily indicated for infections like urinary tract infections and respiratory infections, whereas azithromycin is commonly used for treating atypical pneumonia and certain bacterial infections but lacks effectiveness against Borrelia.