Table 2.

Suggested Treatments for Adult Patients with the Most Common Clinical Manifestations of Lyme Disease in the United States

Manifestation	Antibiotic	Duration	Gradef,g
Erythema migrans	Doxycycline 100 mg orally twice daily	10 daysa	I-A
	Amoxicillin 500 mg orally three times daily	14 daysa	IIa-C
	Cefuroxime axetil 500 mg orally twice daily	14 daysa	IIa-C
Erythema migrans in a patient unable to take beta lactams or tetracyclines	Azithromycin 500 mg orally once daily	7-10 days	IIa-A
Lyme meningitis    Ambulatory	Doxycycline 100 mg orally twice daily or 200 mg once dailyb	14 daysa	IIa-Ce
Hospitalized	Ceftriaxone 2 grams intravenously once daily	14 daysa,c	I-B
Lyme cranial neuropathy or radiculopathy	Doxycycline 100 mg orally twice daily or 200 mg once daily	14 days b,d	IIa-Be
Lyme cranial neuropathy or radiculopathy in a patient unable to take tetracyclines	Amoxicillin 500 mg orally three times daily	14 days a,d	IIa-B
	Cefuroxime axetil 500 mg orally twice daily	14 days a,d	IIa-B
Cardiac Lyme disease    Ambulatory	Same as for erythema migrans	14 days (range 14-21 days)	IIa-C
Hospitalized	Ceftriaxone 2 grams intravenously once daily until stabilized or discharged. Complete course with oral antibiotic recommended for erythema migrans	14 days (range 14-21 days)c	IIa-C IIa-C
Lyme arthritis:   Initial	Doxycycline 100 mg orally twice daily	28 days	IIa-B
	Amoxicillin 500 mg orally three times daily	28 days	IIa-B
	Cefuroxime axetil 500 mg orally twice daily	28 days	IIa-C
Persistent Lyme arthritis after 1st course of oral therapy	Re-treat using one of the above oral regimens	28 days	IIb-C
	Ceftriaxone 2 grams intravenously once daily	14-28 days	IIb-C

^arepresents a change from the 2006 IDSA guidelines² by virtue of elimination of a longer range in duration of therapy (of up to 21 days for erythema migrans and of up to 28 days for meningitis or radiculopathy). Applicable references: ^16,78,79

^brepresents a change from the 2006 IDSA guidelines² by suggesting oral doxycycline rather than parenteral antibiotic therapy (for meningitis or radiculopathy). Applicable references: ^80–84

^con hospital discharge may complete the course of treatment with oral doxycycline for neurologic Lyme disease; for cardiac Lyme disease may complete the course of therapy with any of the first-line oral regimens used for erythema migrans.

^dtreatment does not accelerate rate of recovery of facial palsy but is recommended to prevent other sequelae.

^efor patients who acquire Lyme disease in Europe, this recommendation is I-A.

^fgradings pertain to the antibiotic at the specific dosage and duration. All listed antibiotics have activity against B. burgdorferi (I-A).

^gSee supplemental Table 1 for AHA evidence based scoring system.