Pediatric Lyme Disease Treatment & Management

  • Author: Russell W Steele, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Jan 24, 2012
 

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.

Next

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.

Previous
Next

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A Lyme disease vaccine was licensed by the US Food and Drug Administration (FDA) in 1998 but was subsequently withdrawn from the market in 2002 due to concerns regarding efficacy and side effects.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.

Previous
Next

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.
Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Stephen C Aronoff, MD  Waldo E Nelson Chair and Professor, Department of Pediatrics, Temple University School of Medicine

Stephen C Aronoff, MD is a member of the following medical societies: Pediatric Infectious Diseases Society and Society for Pediatric Research

Disclosure: Nothing to disclose.

Sarah L Wingerter, MD  Attending Physician, Department of Emergency Medicine, St Christopher's Hospital for Children; Clinical Assistant Professor of Pediatrics (Adjunct), Temple University School of Medicine

Sarah L Wingerter, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary J Noel, MD  Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Richard G Bachur, MD, and Marvin Harper, MD, to the development and writing of the source article.

References
  1. Feder HM Jr. Lyme disease in children. Infect Dis Clin North Am. Jun 2008;22(2):315-26, vii. [Medline].

  2. Halperin JJ. Nervous system lyme disease: diagnosis and treatment. Rev Neurol Dis. Winter 2009;6(1):4-12. [Medline].

  3. 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].

  4. 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].

  5. 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].

  6. 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].

  7. [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].

  8. [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.

  9. [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].

  10. 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].

Previous
Next
 
The Ixodes scapularis tick is considerably smaller than the Dermacentor tick. The former is the vector for Lyme disease, granulocytic ehrlichiosis, and babesiosis. The latter is the vector for Rocky Mountain spotted fever. This photo displays an adult I scapularis tick (on the right) next to an adult Dermacentor variabilis; both are next to a common match displayed for scale. Photo by Darlyne Murawski; reproduced with permission.
In general, Ixodes scapularis must be attached for at least 24 hours to transmit the spirochete to the host mammal. Prophylactic antibiotics are more likely to be helpful if feeding is longer. This photo shows 2 I scapularis nymphs. The one on the right is unfed; the other has been feeding for 48 hours. Note its larger size and the fact that the midgut diverticula (delicate brown linear areas on the body) are blurred. Photo by Darlyne Murawski; reproduced with permission.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.