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Treatment

People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Antibiotics commonly used for oral treatment include doxycycline, amoxicillin, or cefuroxime axetil. People with certain neurological or cardiac forms of illness may require intravenous treatment with antibiotics such as ceftriaxone or penicillin.

Treatment regimens listed in the following table are for localized (early) Lyme disease. See references below (Hu 2016; Sanchez 2016) for treatment of patients with disseminated (late) Lyme disease. These regimens are guidelines only and may need to be adjusted depending on a person’s age, medical history, underlying health conditions, pregnancy status, or allergies.

Age Category Drug Dosage Maximum Duration, Days
Adults Doxycycline 100 mg, twice per day orally N/A 10-21*
Cefuroxime axetil 500 mg, twice per day orally N/A 14-21
Amoxicillin 500 mg, three times per day orally N/A 14-21
Children Amoxicillin 50 mg/kg per day orally, divided into 3 doses 500 mg per dose 14-21
Doxycycline 4 mg/kg per day orally, divided into 2 doses 100 mg per dose 10-21*
Cefuroxime axetil 30 mg/kg per day orally, divided into 2 doses 500 mg per dose 14-21

*Recent publications suggest the efficacy of shorter courses of treatment for early Lyme disease.

NOTE: For people intolerant of amoxicillin, doxycycline, and cefuroxime axetil, the macrolides azithromycin, clarithromycin, or erythromycin may be used, although they have a lower efficacy. People treated with macrolides should be closely monitored to ensure that symptoms resolve

The National Institutes of Health (NIH) has funded several studies on the treatment of Lyme disease that show most people recover when treated within a few weeks of antibiotics taken by mouth. In a small percentage of cases, symptoms such as fatigue (being tired) and muscle aches can last for more than 6 months. This condition is known as “Post-treatment Lyme Disease Syndrome” (PTLDS), although it is often called “chronic Lyme disease.” For details on research into “chronic Lyme disease” and long-term treatment trials sponsored by NIH, visit the visit the National Institutes of Health Lyme Disease web site.

References

  • Hu LT. Lyme Disease. Ann Intern Med. 2016 Nov 1;165(9):677.
  • Kowalski  TJ, Tata  S, Berth  W, Mathiason  MA, Agger  WA.  Antibiotic treatment duration and long-term outcomes of patients with early Lyme disease from a Lyme disease-hyperendemic area. Clin Infect Dis. 2010;50(4):512-520.
  • Sanchez E, Vannier E, Wormser GP, Hu LT. Diagnosis, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: A review. JAMA. 2016 Apr 26;315(16):1767-77.
  • Stupica  D, Lusa  L, Ruzić-Sabljić  E, Cerar  T, Strle  F.  Treatment of erythema migrans with doxycycline for 10 days versus 15 days. Clin Infect Dis. 2012;55(3):343-350.
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