TREATMENT OF EARLY LYME DISEASE
Treatment of early Lyme disease is aimed at resolution of symptoms and prevention of late complications. For the treatment of early localized or early disseminated disease without third-degree heart block or neurologic complications in adults, current guidelines recommend doxycycline 100 mg orally twice daily or amoxicillin 500 mg orally three times daily for 14 to 21 days as first-line therapy. Cefuroxime axetil at 500 mg orally twice daily is a costly alternative for patients who cannot tolerate doxycycline or amoxicillin. Pregnancy and lactation are relative contraindications to doxycycline therapy.Pediatric regimens include amoxicillin 50 mg/kg/day orally divided into three doses up to a maximum of 500 mg per dose or, for children 8 years or older, doxycycline 1 to 2 mg/kg/day divided into two doses up to a maximum of 100 mg per dose. Alternative therapy with cefuroxime axetil at 30 mg/kg/day divided into two doses up to a maximum of 500 mg per dose is recommended for children who cannot take amoxicillin or doxycycline. Age < 8 years is a relative contraindication to doxycycline therapy.Macrolides should be reserved for patients who cannot tolerate amoxicillin, doxycycline, or cefuroxime axetil. Adult regimens include azithromycin 500 mg orally daily for 7 to l0 days or erythromycin 500 mg orally four times daily for 14 to 21 days, or clarithromycin 500 mg orally twice daily for 14 to 21 days. Pediatric macrolide regimens include azithromycin 10 mg/kg/day up to a maximum of 500 mg per dose or erythromycin 12.5 mg/kg four times daily up to 500 mg per dose, or clarithromycin 7.5 mg/kg twice daily up to 500 mg per dose.*164/348/5*
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