Infections
Medicines for Lyme disease
A bacterial infection caught from the bite of an infected tick — often heralded by a spreading "bull's-eye" rash and flu-like symptoms, and treated with a course of antibiotics.
Education and reference only. This explains which medicines are used and why, in plain language — it deliberately contains no doses and is not a substitute for advice from your doctor or pharmacist. Always discuss your own treatment with a qualified clinician, and check the BNF and the product labelling for prescribing detail.
Quick answer
What is Lyme disease?
Lyme disease is a bacterial infection spread to people through the bite of an infected tick. Ticks are tiny spider-like creatures that live in woodland, heath, moorland and long grass, and they can pass on the bacteria while feeding on the skin.
- How it is treated: Lyme disease is treated with a course of antibiotics, and the earlier this is started the better the outlook.
- Self-care: Preventing tick bites is the most effective protection.
- When to seek help: See a GP if you develop a spreading circular or "bull's-eye" rash, or an unexplained flu-like illness with tiredness, headache, fever and aching, after spending time outdoors where ticks live — even if you do not recall a bite.
What it is
Lyme disease is a bacterial infection spread to people through the bite of an infected tick. Ticks are tiny spider-like creatures that live in woodland, heath, moorland and long grass, and they can pass on the bacteria while feeding on the skin. The most recognisable early sign is erythema migrans — a gradually spreading, circular or oval rash, often with a clearer centre that gives it the classic "bull's-eye" appearance. It usually appears days to weeks after a bite and is not normally painful or itchy. Many people also feel generally unwell with flu-like symptoms such as tiredness, headache, muscle and joint aches, a high temperature and swollen glands. If the infection is not treated, it can spread later to affect the joints, the nerves (including causing a facial droop) and, less often, the heart. Diagnosis is usually made on the typical rash alone, or with blood tests where the picture is less clear. Most people recover fully after a course of antibiotics, particularly when treatment starts early.
How it is treated
Lyme disease is treated with a course of antibiotics, and the earlier this is started the better the outlook. Where the typical erythema migrans rash is present, treatment is begun straight away without waiting for blood tests, as the rash alone is enough to make the diagnosis. The first-choice antibiotic in adults and older children is doxycycline, a tetracycline. Amoxicillin, a penicillin, is used as an alternative when a tetracycline is not suitable — for example in pregnancy or in young children, in whom tetracyclines are usually avoided. Azithromycin, a macrolide, may be used when neither of these is appropriate. Later or more complicated forms of the disease — such as those affecting the nerves, joints or heart — are treated with antibiotics too, sometimes for longer or given by drip, and may involve specialist care. Removing any attached tick promptly and correctly, and avoiding bites in the first place, are the best ways to prevent infection.
For this condition, these medicines
Medicine classes used for Lyme disease
Each links to a full, dose-free guide — what it is, how it works, who can and cannot use it, side effects, interactions and FAQs.
Symptom checker
Symptoms that can point to Lyme disease
Lyme disease can be one cause of these symptoms. Each guide explains the other possible causes and the red-flag warning signs that mean you should get urgent help:
Beyond medication
Lifestyle and self-care
Preventing tick bites is the most effective protection. When walking in grassy, wooded or moorland areas, keep to paths, cover the skin with long sleeves and trousers tucked into socks, wear light-coloured clothing so ticks are easier to spot, and use an insect repellent. Check your skin, your children and your pets for ticks after being outdoors, paying attention to warm, hidden areas such as the groin, armpits and hairline. If you find a tick, remove it promptly using fine-tipped tweezers or a tick-removal tool, gripping it close to the skin and pulling steadily upwards without twisting or crushing it, then clean the area. Removing a tick quickly lowers the chance of infection. After a bite, keep an eye on the area for several weeks and seek advice if a spreading rash or flu-like illness develops.
When to get help
When to see a doctor
See a GP if you develop a spreading circular or "bull's-eye" rash, or an unexplained flu-like illness with tiredness, headache, fever and aching, after spending time outdoors where ticks live — even if you do not recall a bite. Mention recent walks in grassy or wooded areas, as this helps with the diagnosis. Some features need more urgent assessment: a facial droop or weakness on one side of the face, a severe headache with a stiff neck or sensitivity to light, or palpitations, dizziness or breathlessness can point to the infection affecting the nerves or heart and should be checked without delay.
Not sure how urgent it is? It is always OK to call NHS 111 for advice, day or night.
Answers
Lyme disease: frequently asked questions
What medicines are used for Lyme disease?
Lyme disease is treated with a course of antibiotics, started early for the best outcome. The first choice in adults and older children is doxycycline, a tetracycline. Amoxicillin, a penicillin, is used as an alternative when a tetracycline is not suitable — for example in pregnancy or young children, in whom tetracyclines are usually avoided. Azithromycin, a macrolide, is an option when neither of those can be used. Where the typical "bull's-eye" rash is present, treatment is begun straight away without waiting for blood tests. Later or more complicated infection may need antibiotics for longer or given by drip, sometimes under specialist care.
How do I know if I have Lyme disease?
The clearest early sign is erythema migrans — a gradually spreading circular or oval rash, often with a clearer centre giving a "bull's-eye" look — which usually appears days to weeks after a tick bite and is not normally painful or itchy. Many people also feel generally unwell with flu-like symptoms. If the typical rash is present, a doctor can diagnose Lyme disease on that alone; where the picture is less clear, blood tests can help. See a GP if you develop a spreading rash or an unexplained flu-like illness after being in areas where ticks live.
How do I remove a tick safely?
Remove an attached tick promptly using fine-tipped tweezers or a tick-removal tool. Grip the tick as close to the skin as you can and pull steadily upwards without twisting, jerking or crushing its body, then clean the area and your hands. Avoid burning the tick or covering it with creams, as this is not effective. Removing a tick quickly lowers the chance of infection. After removal, keep an eye on the area for several weeks and seek advice if a spreading rash or flu-like illness develops.
Can Lyme disease be prevented?
There is no vaccine in routine use, so prevention focuses on avoiding tick bites. Keep to paths in grassy, wooded or moorland areas, cover the skin with long sleeves and trousers tucked into socks, wear light-coloured clothing so ticks show up, and use an insect repellent. Check your skin, children and pets after being outdoors, and remove any ticks promptly and correctly. These steps, together with quick removal of any attached tick, greatly reduce the risk of infection.
Keep reading
Related articles
Sources
Where this is drawn from
- NICE NG95: Lyme disease.
- UK Health Security Agency: Lyme disease.
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