Pediatric Lyme Disease Treatment & Management
- Author: Russell W Steele, MD; Chief Editor: Russell W Steele, MD more...
Approach Considerations
Treatment for all stages of Lyme disease requires antibiotics (see Medication). Efforts directed toward prevention are important.
Guidelines have been established for the treatment of nervous system Lyme disease,[7] the management of Lyme disease,[8] and the clinical assessment, treatment and prevention of Lyme disease, granulocytic anaplasmosis, and babesiosis.[9]
Go to Lyme Disease for complete information on this topic.
Antibiotic Therapy
Administer antibiotic therapy to patients who develop a flulike illness within 3 weeks postexposure to a deer tick (in an area endemic for Lyme disease). Beyond 3 weeks, serological testing is appropriate.
Facial nerve palsies improve without treatment; however, antibiotic therapy should prevent late disease. Similarly, arthritis improves without treatment but tends to recur in the same joint or other new joints.
Prevention of Pediatric Lyme Disease
The best prevention for Lyme disease is education and awareness.
Long pants and socks should be worn when in areas of likely tick exposure. Parents of children in endemic areas must be vigilant to check for ticks (especially the nymphs because of their smaller size) from the spring to the fall. Checking inside skin folds, behind ears, the umbilicus, groin, axilla, hairline, and scalp must be routine. Through education, parents can recognize early symptoms and signs.
Insecticides, sprayed on clothing or directly on the skin, can deter ticks, but use of these agents must be weighed against toxicity from overzealous application.
A Lyme disease vaccine was licensed by the US Food and Drug Administration (FDA) in 1998 but was subsequently withdrawn from the market in 2002 due to concerns regarding efficacy and side effects. The vaccine was made of recombinant outer surface protein A (OspA). Newer vaccines are in development.
Prophylactic antibiotics after any tick exposure are not recommended. Even in endemic areas, the risk of transmission from a tick is estimated to be only 1-2%. In hyperendemic areas, a single dose of doxycycline (adults) has been shown to decrease development of disease if given within 72 hours of tick bite.
Preventing exposure and removing ticks promptly is a much better strategy. However, in an endemic area, prolonged attachment, a concerned parent, or pregnancy may prompt consideration of prophylaxis or empiric treatment.
Postexposure prophylaxis has, however, shown some efficacy in an adult study. A single 200-mg dose of doxycycline within 72 hours of the tick bite decreased the development of Lyme disease. The efficacy of oral amoxicillin in children for postexposure prophylaxis has not been adequately studied.
A 2010 meta-analysis examined trials in which patients with no clinical evidence of Lyme disease were randomly allocated to treatment or placebo groups within 72 hours after an Ixodes tick bite.[10] Of the four studies that met the criteria, 1082 randomized subjects were included. The risk of Lyme disease in the control group was 2.2% compared with 0.2% in the antibiotic-treated group. Antibiotic prophylaxis significantly reduced the odds of developing Lyme disease compared with placebo. However, these data are not specific to the pediatric population.
For a known tick exposure, a thorough search for other ticks is necessary. Following discovery of an attached tick, education about symptoms and signs of Lyme disease is the most appropriate treatment.
Consultations
The following consultations may be indicated:
- Infectious disease consultation may be necessary for equivocal diagnoses or prolonged/recurrent symptomatology after seemingly adequate treatment.
- Rheumatology consultation may be indicated for chronic arthritis.
Feder HM Jr. Lyme disease in children. Infect Dis Clin North Am. Jun 2008;22(2):315-26, vii. [Medline].
Halperin JJ. Nervous system lyme disease: diagnosis and treatment. Rev Neurol Dis. Winter 2009;6(1):4-12. [Medline].
Nigrovic LE, Thompson AD, Fine AM, Kimia A. Clinical predictors of Lyme disease among children with a peripheral facial palsy at an emergency department in a Lyme disease-endemic area. Pediatrics. Nov 2008;122(5):e1080-5. [Medline].
Cohn KA, Thompson AD, Shah SS, Hines EM, Lyons TW, Welsh EJ, et al. Validation of a clinical prediction rule to distinguish lyme meningitis from aseptic meningitis. Pediatrics. Jan 2012;129(1):e46-53. [Medline].
Burbelo PD, Issa AT, Ching KH, Cohen JI, Iadarola MJ, Marques A. Rapid, simple, quantitative, and highly sensitive antibody detection for lyme disease. Clin Vaccine Immunol. Jun 2010;17(6):904-9. [Medline]. [Full Text].
Li X, McHugh GA, Damle N, Sikand VK, Glickstein L, Steere AC. Burden and viability of Borrelia burgdorferi in skin and joints of patients with erythema migrans or lyme arthritis. Arthritis Rheum. Aug 2011;63(8):2238-47. [Medline].
[Guideline] Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP, et al. Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. Jul 3 2007;69(1):91-102. [Medline].
[Guideline] The ILADS Working Group. Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti Infect Ther. 2004;2(1 Suppl):S1-13.
[Guideline] Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. Nov 1 2006;43(9):1089-134. [Medline].
Warshafsky S, Lee DH, Francois LK, Nowakowski J, Nadelman RB, Wormser GP. Efficacy of antibiotic prophylaxis for the prevention of Lyme disease: an updated systematic review and meta-analysis. J Antimicrob Chemother. Jun 2010;65(6):1137-44. [Medline].
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