Table 71-1.

Clinical Findings and Treatment^* in Lyme Disease

Stage (Time from Initial Exposure)	Treatment†
Early Localized (7–14 days)
Erythema migrans	Amoxicillin 50 mg/kg/day divided bid or
	Doxycycline‡ 100 mg bid × 14–21 days
Early Disseminated (days to weeks)
Multiple erythema migrans	Amoxicillin (as above) × 21–28 days
Neurologic
Cranial neuropathy (Bell's palsy)	Amoxicillin (as above) × 21–28 days
Radiculoneuritis	Amoxicillin (as above) × 21–28 days
Aseptic meningitis/encephalitis	Ceftriaxone 75–100 mg/kg/day ×
	14–28 days or 30–60 days depending on clinical response
Cardiac
Myopericarditis	Ceftriaxone (as above) × 14–21 days
Atrioventricular block	Cardiology consult
Cardiomegaly	Cardiology consult
Musculoskeletal
Arthralgias	Supportive care
Myalgias	Supportive care
Late Disseminated (weeks to months)
Arthritis	Amoxicillin (as above) × 28 days
Chronic polyneuropathy	Supportive care
Chronic encephalopathy§	Supportive care

^*Treatment for Lyme disease may have different recommendations from different sources; consultation with an infectious disease expert should be considered.

^†Cefuroxime axetil or erythromycin can be used for penicillinallergic patients.

^‡Only in children 8 years or older.

^§Sleep disturbance, fatigue, mood changes, concentration difficulty, and memory loss.