Table III.

Preferred Antimicrobial Therapies for Patients with Lyme Disease^1,2

Manifestation	Drug	Adult Dosage	Pediatric Dosage	Duration (Range)
Early Disease  Erythema migrans	Doxycycline3	100 mg po BID	<8 years – not recommended ≥8 years – 4 mg/kg/d in two divided doses (maximum 100 mg/dose)	14 days (10–21 days)
	Amoxicillin	500 mg po TID	50 mg/kg/day in three divided doses (maximum 500 mg/dose)	14 days (14–21 days)
	Cefuroxime axetil	500 mg po BID	30 mg/kg/day in two divided doses (maximum 500 mg/dose)	14 days (14–21 days)
Early Neurologic Disease
Cranial nerve palsy4	Same as for EM			14 days (14–21 days)
Meningitis or radiculopathy5	Ceftriaxone	2 g IV qd	50–75 mg/kg IV qd in a single dose (maximum 2 g/day)	14 days (10–28 days)
Cardiac Disease	Same as oral regimen for EM OR use IV regimen as for neurologic disease6	2 g IV qd	50–75 mg/kg IV qd in a single dose (maximum 2 g/day)	14 days (14–21 days)
Late Disease
Arthritis without neurologic	Same as for EM			28 days (28 days)
Recurrent arthritis after oral regimen	Repeat oral regimen OR use IV regimen as for neurologic disease			28 days for oral regimens and 14–28 days for IV regimens
Central or Peripheral Nervous System Disease	IV regimen as for early neurologic disease			14 days (14–28 days)

¹A complete list of recommended and alternate therapies can be found in reference 37.

²Complete response to treatment may be delayed beyond the treatment period, regardless of the clinical manifestation, and relapse may recur. Patients with objective signs of relapse may need a second course of treatment.

³Tetracyclines are relatively contraindicated in pregnant or lactating women and in children < 8 years of age.

⁴Patients without clinical evidence of meningitis may be treated with an oral regimen. The recommendation is based on experience with seventh cranial nerve palsy. Whether oral therapy would be as effective for patients with other cranial neuropathies is unknown; the decision between oral and parenteral therapy should be individualized.

⁵For non-pregnant adult patients intolerant of beta-lactam agents, doxycycline 200–400 mg/day orally (or IV if unable to take oral medications) in two divided doses may be adequate. For children ≥ 8 years of age, the dosage of doxycycline for this indication is 4–8 mg/kg/d in two divided doses (maximum daily dosage of 200–400 mg).

⁶A parenteral antibiotic regimen is recommended at the start of therapy for patients who have been hospitalized for cardiac monitoring; an oral regimen may be substituted to complete a course of therapy or to treat outpatients. A temporary pacemaker may be required for patients with advanced heart block.