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Since recognition in 1975, Lyme disease has become the most common vector-borne illness in North America and Europe. The clinical features are well-characterized and treatment is usually curative, but misperceptions about morbidity persist. The purpose of this review is to examine advances in the diagnosis and treatment of Lyme disease, as well as ongoing management challenges. It is useful to recognize that Lyme disease occurs in stages, with early- and late-stage disease. Clinical expression is in part determined by Borrelial variability. For example, some strains of Borrelia burgdorferi, the causative organism in North America, are particularly arthritogenic. Most patients with early Lyme disease can be cured with a single course of oral antibiotic therapy, in contrast to some patients with Lyme arthritis, a late-stage manifestation, who are more antibiotic refractory and require other treatment strategies. Successful treatment of Lyme disease begins with successful diagnosis and with an understanding of the emergence, clinical features, and impact of Lyme disease over the past half century.

Any antibiotic agent that improves the safety of antibiotic treatment means progress in the management of infectious diseases. A new antibiotic has to show the following properties in order to signify progress compared to the well established antibiotics: Better antibacterial activity, better pharmacokinetic and pharmacodynamic properties, which improve patient compliance. Reduction of costs for antibiotic treatment also means progress. Infections most frequently seen in outpatients who are usually treated with oral antibiotics are respiratory and urinary tract infections. Progress in the management of infectious diseases by the introduction of quinolones, combination of amoxicillin-clavulanic acid, new macrolides and new oral cephalosporins is discussed.