Treatment of Lyme Disease
Apr 24, 2008
Author: Canadian pharmacy
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Table 2. Treatment of Lyme Disease |
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Stage |
Antibiotic Regimen |
Treatment Considerations |
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Early localized |
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Erythema migrans |
Doxycycline, 100 mg PO bid x 14-21 days* or Amoxicillin, 500 mg PO tid x 14-21 days (pediatric dosage: 30-50 mg/kg/day, not to exceed adult dose) or Cefuroxime axetil (Ceftin), 500 mg PO bid x 14-21 days |
Multiple erythema migrans without neurologic involvement is treated with same regimens. Macrolides (ie, erythromycin and azithromycin [Zithromax]) have some effect on disease progression and duration of erythema migrans, but failures are more common with these drugs than with other, preferred agents. |
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Disseminated and Late† |
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Neurologic
Cardiac
Arthritis |
Ceftriaxone sodium (Rocephin),2 g/day IV x 14-28 days (pediatric dosage:50 to 100 mg/kg/day IV) or Cefotaxime sodium (Claforan), 2 g q8h IV x 14-28 days (pediatric dosage: 90 to 180 mg/kg/day in three doses) or Penicillin G, 3.5-4 million U IV q4h x 14-28 days (pediatric dosage: 300,000 U/kg/day IV) Doxycycline, 100 mg PO bid x 21 days or Amoxicillin, 500 mg PO q8h x 21 days or Ceftriaxone, 2 g/day IV x 14-21 days Amoxicillin, 500 mg PO qid x 28 days or Doxycycline, 100 mg PO bid x 28 days or Ceftriaxone, 2 g/day IV x 14 days |
Neurologic Lyme disease limited to facial nerve palsy has been treated successfully with oral therapy.
Oral therapy is usually reserved for mild cardiac involvement (first-degree atrioventricular block with PR interval <0.30 sec).
Oral regimens are preferred unless patient has concurrent neurologic involvement. If initial course of oral therapy fails, course may be extended for total of 8 wk or a 2-wk course of IV therapy may be given. If extended treatment is not effective, patient should undergo arthroscopic synovectomy. |
*Tetracyclines should not be given to children younger than 9 years or women who are pregnant or lactating.
†Late disease generally responds more slowly than acute disseminated disease.