Antibiotic therapy is the treatment of choice for Lyme disease. The antibiotic used, route of
administration and duration of antibiotic therapy is determined by stage of infection. For
example, patients diagnosed with Stage I infection will often experience relief from symptoms
after a three to four week course of oral antibiotic therapy. By contrast, Stage II infection usually
is system specific and may require IV antibiotic treatment. Table 2 outlines a typical treatment
schedule based upon the presenting symptoms associated with Lyme disease (ACP, 1999).
| Treatment of |
Dosing |
| Early infection — uncomplicated erythema migrans or
multiple erythema migrans |
Adults:
Amoxicillin 500 mg tid for 21 days
OR
Doxycycline 100 mg bid for 21 days*
Children under age 10:
Amoxicillin 40 mg/kg qd in three divided doses for
21 days (max dose 500 mg)
Children over age 10:
Amoxicillin 40 mg/kg qd in three divided doses for
21 days (max dose 500 mg)
OR
Doxycycline 100 mg bid for 21 days |
| Erythema Migrans in Pregnancy |
Amoxicillin 500mg tid for 21 days |
| Cranial Neuropathy alone/Facial Palsy
Meningitis/Acute Radiculopathy |
Amoxicillin 500 mg tid for 21 days
OR
Doxycycline 100 mg bid for 21 days
OR
Ceftriaxzone 2 g q 8 hours for 21 - 28 days**
OR
Cefotaximine 2 g q 8 hours for 21 -28 days
Ceftriaxzone 2 g qd for 21 - 28 days
OR
Cefotaximine 2 g q 8 hours for 21 -28 days |
| Lyme Arthritis |
Amoxicillin 500 mg tid for 28 days (with or without
probenecid)
OR
Doxycycline 100 mg bid for 28 days
OR
Ceftriaxzone 2 g iv qd for 21-28 days
OR
Cefotaxime 2 g q 8 hours for 21 - 28 days |
| Lyme Encephalopathy/Chronic Radiculoneuritis |
Ceftriaxzone 2 g iv qd for 21-28 days
OR
Cefotaxime 2 g q 8 hours for 21 - 28 days |
| *Doxycycline and tetracycline are contraindicated in children under age ten and pregnancy.
**Pediatric dose: Ceftriaxzone 40 mg/kg qd for 21 - 28 days. All doses for children must be adjusted
appropriately.
SOURCE: American College of Physicians (ACP, 1999) |
