Table 3.
Therapy for persistent Lyme arthritis refractory to the first antibiotic treatment
| Persistent Lyme arthritis | ||
|---|---|---|
| Antibiotic-refractory persistent arthritis | Significant inflammation (effusion, limited range of motion, oligoarthritis) | Repeat |
| • Intravenous cefotaxime 50 mg/kg/day in one dose (maximum dose 2,000 mg/day) | ||
| • Intravenous cefotaxime 200 mg/kg/day in three divided doses (maximum dose 6,000 mg/day) | ||
| • Intravenous penicillin G 0.5 million U/kg/day in four to six divided doses (maximum 20 million U/day) | ||
| for 14 days up to 28 days | ||
| Limited inflammation (for example, monoarthritis) | • Doxycycline 4 mg/kg/day in two divided doses (maximum 200 mg/day; after 8 years of age) | |
| for 28 days | ||
| Additional anti-inflammatory therapy: nonsteroidal anti-inflammatory drugs | ||
| No remission reached | In synovial fluid or synovia: | Prolong antibiotic oral treatment for another month |
| B. burgdorferi DNA present | Consider | |
| • Intra-articular steroid injection | ||
| • Disease-modifying antirheumatic drug therapy | ||
| • Arthroscopic synovectomy | ||
| B. burgdorferi DNA not present | Consider | |
| • Intra-articular steroid injection | ||
| • Disease-modifying antirheumatic drug therapy | ||
| • Arthroscopic synovectomy | ||