Table 3.

Treatment of Lyme Disease.

Condition and Recommended Drug	Dose*	Duration†	Comments‡
		days
Erythema migrans
Doxycycline (for patients ≥8 yr of age)	200 mg/day (pediatric dose, 4 mg/kg/day) orally, divided into two doses per day	14 (range, 10–21)	Do not use to treat children <8 yr of age or women who are pregnant or lactating; warn patient about exposure to sun, since photosensitivity rash occurs in 20–30% of patients; drug has good penetration into the central nervous system; patient should take drug with fluids to minimize nausea and gastrointestinal irritation; also effective against granulocytic anaplasmosis but not against babesiosis
Amoxicillin	1500 mg/day (pediatric dose, 50 mg/kg/day) orally, divided into three doses per day	14 (range, 14–21)	This agent is not effective against granulocytic anaplasmosis or babesiosis
Cefuroxime axetil	1000 mg/day (pediatric dose, 30 mg/kg/day) orally, divided into two doses per day	14 (range, 14–21)	This agent is not effective against granulocytic anaplasmosis or babesiosis
Meningitis§
Ceftriaxone	2 g/day (pediatric dose, 50–75 mg/kg/day) intravenously once per day	14 (range, 10–28)	Treatment has risks associated with indwelling catheters, including infection, and can cause pseudolithiasis in the gallbladder
Cefotaxime	6 g/day (pediatric dose, 150– 200 mg/kg/day) intravenously, divided into doses administered every 8 hr	14 (range, 10–28)	Treatment has risks associated with indwelling catheters, including infection
Cranial-nerve palsy without clinical evidence of meningitis¶
Doxycycline (for patients ≥8 yr of age)	200 mg/day (pediatric dose, 4 mg/kg/day) orally, divided into two doses per day	14 (range, 14–21)
Amoxicillin	1500 mg/day (pediatric dose, 50 mg/kg/day) orally, divided into three doses per day	14 (range, 14–21)	See comments for drugs used to treat erythema migrans; there is not good evidence that treatment changes the outcome of facial palsy, but it does prevent additional sequelae of infection
Cefuroxime axetil	1000 mg/day (pediatric dose, 30 mg/kg/day) orally, divided into two doses per day	14 (range, 14–21)
Carditis
Same oral agents as for erythema migrans; same parenteral agents as for meningitis	Same doses as for oral and parenteral agents used to treat erythema migrans	14 (range, 14–21)	Patients who are symptomatic should be hospitalized, monitored, and treated initially with a parenteral agent such as ceftriaxone; some patients with advanced heart block require a temporary pacemaker; after advanced block resolves, treatment may be completed with an oral agent
Arthritis
Same oral agents as for erythema migrans; same parenteral agents as for meningitis	Same doses as for oral and parenteral agents used to treat erythema migrans	28	Nonsteroidal antiinflammatory agents are often helpful as adjunctive treatment; for patients in whom arthritis persists or recurs, most experts recommend a second 28-day course of oral treatment; 14–28 days of parenteral treatment is an alternative

^*For each drug, the maximum pediatric dose is the adult dose.

^†Recommendations are from the Infectious Diseases Society of America.

^‡A reaction similar to the Jarisch–Herxheimer reaction may occur in the first 24 hours after treatment is begun.

^§There is evidence from Europe that treatment of meningitis with doxycycline administered orally is as good as parenteral treatment, although the species of borrelia that cause Lyme meningitis in Europe may be different from that in the United States.²⁹

^¶Doxycycline is preferable because of its good penetration into the central nervous system.