Ask a doctor on the topic of Internal medicine

Explanations, advice, and therapy monitoring for Lyme disease infection.

August 5, 2018 | 66,00 EUR | answered by Dr. med. Frauke Gehring

Dear Sir or Madam,

I am male, 35 years old, 77 kg, 180 cm tall, and I take Dekristol 20000 once a week. On Sunday, 01.07.2018, I discovered a tick on myself in the Munich train station area and had it removed at the hospital, however, the mouthpiece remained in the skin and the tick was disposed of (left lower leg). This was my first known tick bite. On Monday, 23.07.2018, redness appeared at the tick bite site (approximately 1 cm in diameter), the doctor ordered a blood test, which showed no evidence of Borrelia (Borrelia IgM antibodies (LIA) negative / Borrelia IgG antibodies (LIA) less than 10 U/ml). Within a week, the redness spread to about 4-5 cm, so I went back to the doctor on Monday, 30.07. Since then, I have been taking Doxycycline AL 200 T once a day in the morning. The pharmacist also sold me Omni BioTic 10 for gut cleansing, which I took once a day with lunch during the week. Throughout the week of antibiotic therapy, the redness spread, as well as sharp knee pain, muscle soreness in the thighs, and pain in the lumbar spine area. Therefore, I visited the doctor again on Thursday, 02.08, but he advised me to wait another week. If there is no improvement in symptoms by then, I should come back to the practice.

For your better assessment, here are a few pictures:
IMG_5905: This picture was taken on Wednesday, 25.07., as the redness slowly began to spread.
IMG_6034: This picture was taken on the third day of antibiotic therapy (Wednesday, 01.08), showing how the redness had spread further (the black circle marks the spread of the redness on the first day of antibiotic therapy).
IMG_6121: This photo is from today, Sunday, 05.08. - you can see a lightening of the redness.

I was greatly concerned that my symptoms worsened during antibiotic treatment: Therefore, I asked myself, how do I know if the antibiotic is working? Perhaps the antibiotic is ineffective because, for example, the maximum storage temperature of 25 °C has been exceeded. Could it be that due to the increased outside temperatures (room temperature about 30 °C), the antibiotic becomes ineffective? After all, the packaging states that the maximum storage temperature should only be 25 °C. How can you tell if heat has damaged a medication? How should I best store the antibiotic at home - in the refrigerator?

Another suspicion as to why the effect might be at least weakened was my unsuitable diet. I ate about 100 g of whole grain bread during antibiotic intake and drank fruit juice (TrueFruits + grated ginger) 1-2 hours later. Currently, I completely skip the fruit juice and eat 1 wheat roll with hummus during antibiotic intake and avoid cheese and milk as much as possible throughout the time - is that okay? Or can you tell me what is best to eat with the antibiotic? Can I consume calcium-rich foods, fruit juices, milk, cheese, and non-alcoholic beer about 4 hours after taking antibiotics? I also took probiotics for gut cleansing about 4 hours after taking the antibiotics - I am currently refraining from this. Would you recommend probiotics for gut cleansing? Or should I start after antibiotic therapy? Maybe the antibiotic is not working for me for some reason (I have read that 10% of people are treatment failures, whatever that may mean). And finally: just because the symptoms may disappear after days/weeks does not mean that Lyme disease has been defeated, you may also be in transition to the next stage... How do I know if the antibiotic is working and I will be free of Lyme disease? Can it be said that if I have no symptoms after 5 years, that the antibiotic has worked, or can the Borrelia cause problems again later (assuming there was no re-infection)?

I plan to attend a festival from Friday, 10.08 to Monday, 13.08, where shaded areas are scarce. Sun protection is an issue, and another is the storage of the antibiotic (in tents, the temperature is likely to be even higher than the maximum storage temperature). How should I best store the antibiotic at the festival? Would you advise against me attending the festival? After all, it is also associated with a lot of stress (lots of walking, setting up tents, being in the sun all day).

Should I avoid stress during antibiotic therapy, including exercise? Such as jogging (30 minutes daily), cycling (15 km per day)?

How long is the erythema

Dr. med. Frauke Gehring

Good evening,

I am happy to answer you in order:

1.) Yes, that is possible.
2.) It is not necessarily visible, discoloration can be an indication.
3.) The medication is well kept in the refrigerator.
4.) That is okay, it is also sufficient to wait two hours after consuming milk.
5.) No dairy products, the rest does not matter.
6.) You may.
7.) Yes, I recommend it, and you can start now.
8.) I consider over 400 mg to be unnecessary and harmful, that is already a high dosage.
9.) One can never be sure, but it is extremely unlikely that it will not help.
10.) In a small cooler box.
11.) Yes, if you continue to not feel well.
12.) Absolutely!
13.) With or without therapy, around two to three weeks.
14.) The general practitioner or internist.

Get well soon!

Sincerely, Dr. Gehring