Intravenous (IV) Antibiotics for Lyme Disease?

The topic of intravenous antibiotic therapy is quite controversial when it comes to treating Lyme disease. In this post I am sharing an excerpt from my recently published book, “The Top 10 Lyme Disease Treatments.” The post also has a diagram of antibiotics and their relative benefit in Lyme disease according to my research.

This is an excerpt taken from the book seen at right.


As discussed earlier in this chapter, treating Lyme Disease is a marathon, not a sprint.  In other words, the most effective antibiotic therapy is that which is spread out over time in moderate doses, not that which is used at high doses for a short period of time.  Because IV antibiotics are generally used in short courses at higher doses, they are not as desirable in the treatment of chronic Lyme Disease as are oral antibiotics.  In addition, given the lengthy course of treatment necessary in chronic Lyme Disease, oral antibiotics are substantially more affordable, safe, convenient, flexible, and practical.  Therefore, oral antibiotics should generally be preferred to IV antibiotics when treating chronic Lyme Disease. 

Many Lyme Disease practitioners will disagree with this position because their philosophy is to hit the infection as hard as possible in a short period of time, and this is usually accomplished with IV antibiotics.  It is true that certain people will recover by using that approach.  In some cases, IV antibiotics do provide excellent results. However, the research relied on in writing this book points to the use of oral antibiotics instead of IV antibiotics. 

Ultimately, all Lyme Disease sufferers must be empowered, do their own homework, do their own thinking, and come to their own conclusions.  The truth is that chronic Lyme Disease treatment is a pioneering and experimental field, not a precise science.  As such, there are gray areas that have yet to be completely understood.  Instead of viewing this book as the final word in Lyme Disease treatment, view it as a platform from which you will be equipped to conduct your own research and make your own decisions.  This goes for your conclusion about IV antibiotics as well.

It should be noted that there are certain cases in which IV antibiotic use is definitely preferred over oral antibiotic use.  Discuss this issue with your physician.  The advice of a trained physician who knows your unique situation should be considered superior to the information in this book. Hopefully your physician is open-minded enough to have an open discussion with you about these questions.

Antibiotic Summary Chart

Antibiotic Class

Drug  names in this class


Cell Wall Inhibitors

Cephalosporins:  Aztreonam (Azactam® for injection) Cefaclor (Ceclor®), Cefadroxil (Duricef®), Cefamandole (Mandol®), Cefazolin (Ancef®, Kefzol®), Cefdinir (Omnicef®), Cefepime (Maxipime®), Cefixime (Suprax®), Cefoperazone (Cefobid®), Cefotaxime (Claforan®), Cefotetan (Cefotan®), Cefoxitin (Mefoxin®), Cefpodoxime (Vantin®), Cefprozil (Cefzil®), Ceftazidime (Ceptaz®, Fortaz®, Tazicef®, Tazidime®), Ceftibuten (Cedax®), Ceftizoxime (Cefizox®), Ceftriaxone (Rocephin®), Cefuroxime (Ceftin®, Kefurox®, Zinacef®), Cephalexin (Keflex®, Keftab®), Cephapirin (Cefadyl®), Cephradine (Anspor®, Velocef®), Imipenem and Cilastatin (Primaxin I.V.®), Loracarbef (Lorabid®), Meropenem (Merrem I.V.®)

Penicillins:  Amoxicillin (Amoxil®, Trimox®), Amoxicillin and Clavulanate (Augmentin®), Ampicillin (Principen®, Totacillin®), Ampicillin and Sulbactam (Unisyn®), Bacampicillin (Spectrobid®), Carbenicillin (Geocillin®), Cloxacillin (Cloxapen®), Dicloxacillin (Dynapen®, Dycill®), Mezlocillin (Mezlin®), Nafcillin (Unipen®), Oxacillin (Bactocill®), Penicillin G (Bicillin C-R®, Bicillin L-A®, Pfizerpen®), Penicillin V (Beepen-VK®, Veetids®), Piperacillin (Pipracil®), Piperacillin and Tazobactam (Zosyn®), Ticarcillin (Ticar®), Ticarcillin and Clavulanate (Timentin®)

Worst Choice!

Protein Synthesis Inhibitors

Macrolides:  azithromycin (Zithromax®), clarithromycin (Biaxin®), dirithromycin (Dynabac®), roxythromycin (Rulid®)

Tetracyclines:  tetracycline, minocycline (Minocin®), doxycycline, demeclocycline

Lincosamides:  Clindamycin

Ketolides: telithromycin (Ketek®)―caution: serious side effects


Anti-protozoals and anti-malarials, (cyst-form drugs)

5-nitroimidazoles:  tinidazole (Fasigyn®), metronidazole (Flagyl®), secnidazole, and ornidazole (Tiberal®) are three most used.  Tinidazole, ornidazole, and secnidazole have the least side effects, but metronidazole has the smallest molecule size which might allow it to achieve higher tissue concentrations.






  • bob

    My mom has been diagonsed with lymes and is on iv antibiotic. Her symptoms were very severe. At first we thought it was a stroke, she couldent talk, walk or even eat. She is in her late 70’s and seems to be recovering. Lymes is very scary, she was in hospital for 7 days. I think i too may have lymes as i have been very, very tired for the past year and was bittn by a tick. Im waiting for test results. Many thanks to the dedicated medical professional staff who help those with this terrible inflection.

  • Linda

    I have to disagree with your idea that long steady oral antibiotic treatment works best. Maybe if you can tolorate the nausea and vomiting that can occur, which are a problem for many. AND ONLY IF the Lyme is caught early and it has not crossed the blood/brain barrier. Once neurological symptoms are present a more aggressive treatment is needed. Oral antibiotics are a waste of valuable time if symptoms persist or reoccur. You are right, it is a marathon yet it is important to approach it aggresivly. The first course of treatment should always be oral antibiotics, but please don’t discount IV antibiotic treatment the way that you have. IV antibiotics are very strong, but they are usually given over a 4-6 week period…hardly a sprint! They are both equally important treatments, based on symptoms and how long between infection and diagnosis.

  • Melissa

    I am looking at the possibility of going on IV antibiotics for yet another fight with Chronic Lyme. It is so bad that I do not even care what they do to me as long as it goes away. I am barely able to wlk some days after work, I crawl up the stairs to bed.

  • SusanL

    I’m wondering what you mean/why the first category of drugs are considered “Worst Choice”? and what makes the others acceptable?

    I’d like to be armed with facts when I present this to my doctor.


  • Bryan Rosner

    It is explained in my book, , basically it depends on which drugs coax cyst conversion and which don’t.


  • Cindi

    I battled Lyme for 5 years (1994-1999) and had 3 courses of IV antibiotics (Rocephin) over that time as well as oral antibiotics. I went into a sort of “remission” several times where my WB showed few bands and my symptoms improved to where I felt almost normal, but continued to relapse. I agree, it was a marathon, not a sprint. My last round of IV I decided to try a NO SUGAR, no simple carb (almost Atkins but didn’t even know what Atkins was at the time) diet. I had been told several times that bacteria thrived on sugar and I was full of it. I had constant problems with candida and at the very least, hoped to improve that. This was how I finally got well. It was a lot harder to cut sugar and refined carbs out of my diet (right down to no catsup!) than pop antibiotics. I felt worse before I got better but I did get better and stay better for 10 years now. I wouldn’t say rule out IV antibiotics but they are a fortune, not usually covered by insurance and there are other risks having the port or pic line in — once I did get septic, rushed to the ER with a 105.8 fever, for example. God obviously wasn’t ready for me just yet!

  • Loriecornett

    I have 2 positive Lyme results, spent time in a well known hospital in Ky. My ID still says it is not Lyme. I know what happens when I am off the antibiotics. I must find someone to treat me. I am a single mother with 3 jobs. Currently on PO Doxy, and IV Rocephin. Help

  • Kathm18

    I live in Australia and have had what could be Lymes disease. I am waiting for the results of a blood test CD57 – borrillia. It has taken me this long to find a doctor that even believes in this disease. In that time I have been diagnosed  twice as suffering bi-pola and once with delusional parasitosis.  It came to the point where I only had  to look at the doctors facial expressions (8 doctors) to come to the conclusion I was quite mad.  I do hope that at last I can find some help for thei dreadful ailment. What ever I have I caught from my sister and this they tell me is not possible.  Just another hurdle for us both. 

  • Rob

    We have an incredible lyme literate doctor here in Hendersonville, TN (just north of Nashville) His name is Dr. Michael R. Bernui @ The Center for Restorative Care  615-338-1023.  He’s helped several of us to the path of healing w/ lyme, bartonella and babesia.  He’s been a total blessing in our lives!  By the way Bryan Rosner’s books are amazing. They empower people w/ lyme. Dr. Bernui has Bryan’s books, and we’ve discussed them on many occasions.  It made me appreciate my doctor even more knowing that he leaves no stone unturned in the quest to heal his patients.  All the best to you on your search for healing! God bless!

  • Sponder1

     Rob, I am seeing Dr. Bernui for lyme and possibly co-infections. I am so thankful that I was able to get in with him! Your post has given me encouragement also! Praying that you and your family are healed completely!

  • Lynn

    I have just got a positive test result for lyme disease after a year with a cardiologist.  I am looking for a good lyme doctor in the upper New York area as I am from Toronto.  Any suggestions?

  • Anonymous

    What doesn’t seem to be considered here is that if the infection has spread to the brain, as is common in chronic lyme disease, oral antibiotics can’t breach the blood brain barrier which protects the cerebrum. What this means is that oral antibiotics cannot treat many individuals with chronic lyme due to the body’s anatomical structure and physiology.

  • Bryan Rosner

    Many oral antibiotics have good CNS penetration. Some do not. You have to know which you are using.