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SymptomsTreatmentFirst alternativeSecond alternative

Lyme disease without focal symptoms

Erythema migrans and/or

Non-focal symptoms

Oral doxycycline:

100 mg twice per day or 200 mg once per day for 21 days

Oral amoxicillin:

1 g 3 times per day for 21 days

Oral azithromycin:†

500 mg daily for 17 days

Lyme disease with focal symptoms

Lyme disease affecting the cranial nerves or peripheral nervous system

Oral doxycycline:

100 mg twice per day or 200 mg once per day for 21 days

Oral amoxicillin:

1 g 3 times per day for 21 days

Lyme disease affecting the central nervous system

Intravenous ceftriaxone:

2 g twice per day or 4 g once per day for 21 days (when an oral switch is being considered, use doxycycline)

Oral doxycycline:

200 mg twice per day or 400 mg once per day for 21 days

Lyme disease arthritis

Oral doxycycline:

100 mg twice per day or 200 mg once per day for 28 days

Oral amoxicillin:

1 g 3 times per day for 28 days

Intravenous ceftriaxone:

2 g once per day for 28 days

Acrodermatitis chronica atrophicans

Lyme carditis†

Oral doxycycline:

100 mg twice per day or 200 mg once per day for 21 days

Intravenous ceftriaxone:

2 g once per day for 21 days

Lyme carditis and haemodynamically unstable

Intravenous ceftriaxone:

2 g once per day for 21 days (when an oral switch is being considered, use doxycycline)

* For Lyme disease suspected during pregnancy, use appropriate antibiotics for stage of pregnancy.

 

† Do not use azithromycin to treat people with cardiac abnormalities associated with Lyme disease because of its effect on QT interval.

 

Table 2: Antibiotic treatment for Lyme disease in children (under 12)*†‡
SymptomsAgeTreatmentFirst alternativeSecond alternative

Lyme disease without focal symptoms

Erythema migrans and/or

Non-focal symptoms

9–12 years

Oral doxycycline* for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days

For severe infections, up to 5 mg/kg daily for 21 days

Oral amoxicillin for children 33 kg and under:

30 mg/kg 3 times per day for 21 days

Oral azithromycin§,, e for children 50 kg and under:

10 mg/kg daily for 17 days

Under 9

Oral amoxicillin for children 33 kg and under: 30 mg/kg 3 times per day for 21 days

Oral azithromycin§, for children 50 kg and under:

10 mg/kg daily for 17 days

Lyme disease with focal symptoms

Lyme disease affecting the cranial nerves or peripheral nervous system

9–12 years

Oral doxycycline* for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days

For severe infections, up to 5 mg/kg daily for 21 days

Oral amoxicillin for children 33 kg and under:

30 mg/kg 3 times per day for 21 days

Under 9

Oral amoxicillin for children 33 kg and under:

30 mg/kg 3 times per day for 21 days

Lyme disease affecting the central nervous system

9–12 years

Intravenous ceftriaxone for children 50 kg and under:

80 mg/kg once per day for 21 days

Oral doxycycline* for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days

For severe infections, up to 5 mg/kg daily

Under 9

Intravenous ceftriaxone for children 50 kg and under:

80 mg/kg once per day for 21 days

Lyme arthritis or

Acrodermatitis chronica atrophicans

9–12 years

Oral doxycycline* for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 28 days

For severe infections, up to 5 mg/kg daily for 21 days

Oral amoxicillin for children 33 kg and under:

30 mg/kg 3 times per day 28 days

Intravenous ceftriaxone for children 50 kg and under:

80 mg/kg once per day for 28 days

Under 9

Oral amoxicillin for children, 33 kg and under:

30 mg/kg 3 times per day for 28 days

Intravenous ceftriaxone for children 50 kg and under:

80 mg/kg once per day for 28 days

Lyme carditis (both haemodynamically stable and unstable)¶

9–12 years

Oral doxycycline* for children under 45 kg:

5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days

For severe infections, up to 5 mg/kg daily for 21 days

Intravenous ceftriaxone for children 50 kg and under:

80 mg/kg once per day for 21 days

Under 9

Intravenous ceftriaxone for children 50 kg and under:

80 mg/kg once per day for 21 days

* At the time of publication (April 2018), doxycycline did not have a UK marketing authorisation for this indication in children under 12 years and is contraindicated. The use of doxycycline for children aged 9 years and above in infections where doxycycline is considered first line in adult practice is accepted specialist practice. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.

 

 Discuss management of Lyme disease in children and young people with a specialist, unless they have a single erythema migrans lesion with no other symptoms, see recommendation 1.3.2.

 

 Children weighing more than the amounts specified should be treated according to Table 1.

 

§ At the time of publication (April 2018), azithromycin did not have a UK marketing authorisation for this indication in children under 12 years. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should be obtained and documented. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information.

 

¶ Do not use azithromycin to treat people with cardiac abnormalities associated with Lyme disease because of its effect on QT interval.