eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Lyme Disease: Treatment & Medication

Author: Stephen C Aronoff, MD, Waldo E Nelson Chair and Professor, Department of Pediatrics, Temple University School of Medicine
Coauthor(s): 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
Contributor Information and Disclosures

Updated: Apr 17, 2009

Treatment

Medical Care

  • Treatment for all stages of Lyme disease requires antibiotics (see Medication). 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.
  • 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.
  • Postexposure prophylaxis has some efficacy in an adult study. A single 200-mg dose of doxycycline within 72 hours of tick bite decreased development of Lyme disease. Data are insufficient to recommend amoxicillin prophylaxis in children.
  • Guidelines have been established for the treatment of nervous system Lyme disease,4 the management of Lyme disease,5 and the clinical assessment, treatment and prevention of Lyme disease, granulocytic anaplasmosis, and babesiosis.6

Consultations

  • For equivocal diagnoses or prolonged/recurrent symptomatology after seemingly adequate treatment, an infectious disease consultation may be necessary.
  • Rheumatology consultation may be indicated for chronic arthritis.

Medication

The antibiotic regimen for Lyme disease depends on the stage and manifestations of the disease.

Antibiotics

The goal of pharmacotherapy with antibiotics is to reduce morbidity and prevent complications. Antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.


Amoxicillin (Amoxil, Trimox, Biomox)

DOC for early localized and early disseminated disease without evidence of CNS involvement. Can be used for arthritis that is not persistent or recurrent.

Adult

500-1000 mg PO tid
Early localized disease: Treat for 14-21 d
Early disseminated disease and late disease:
Multiple EM or facial nerve palsy: Treat for 21-28 d
Arthritis: Treat for 28 d

Pediatric

50 mg/kg/d PO divided tid; not to exceed 3 g/d
Early localized disease: Treat for 14-21 d
Early disseminated disease and late disease:
Multiple EM or facial nerve palsy: Treat for 21-28 d
Arthritis: Treat for 28 d

Reduces the efficacy of PO contraceptives

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal impairment


Doxycycline (Bio-Tab, Doxy, Vibramycin)

DOC for early localized and early disseminated disease without evidence of CNS involvement. Can be used for arthritis that is not persistent or recurrent. Has also been promoted for single-dose postexposure prophylaxis.

Adult

100 mg PO bid
Early localized disease: Treat for 14-21 d
Early disseminated disease and late disease:
Multiple EM or facial nerve palsy: Treat for 21-28 d
Arthritis: Treat for 28 d

Pediatric

<8 years: Not recommended
>8 years: Administer as in adults

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of PO contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one-half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines


Cefuroxime (Ceftin, Kefurox)

Can be used for early localized and early disseminated disease without evidence of CNS involvement. Can be used for arthritis that is not persistent or recurrent.

Adult

500 mg PO bid
Early localized disease: Treat for 14-21 d
Early disseminated disease and late disease:
Multiple EM or facial nerve palsy: Treat for 21-28 d
Arthritis: Treat for 28 d

Pediatric

30 mg/kg/d PO divided bid; not to exceed 1 g/d
Early localized disease: Treat for 14-21 d
Early disseminated disease and late disease:
Multiple EM or facial nerve palsy: Treat for 21-28 d
Arthritis: Treat for 28 d

Disulfiramlike reactions may occur when alcohol is consumed within 72 h after taking cefuroxime; may increase hypoprothrombinemic effects of anticoagulants; may increase nephrotoxicity in patients receiving potent diuretics (eg, loop diuretics); coadministration with aminoglycosides increase nephrotoxic potential

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Administer half dose if creatinine clearance is 10-30 mL/min and one-quarter dose if <10 mL/min; fungal and microorganism overgrowth may occur with prolonged therapy


Ceftriaxone (Rocephin)

DOC for CNS infections (eg, meningitis, multiple cranioneuropathies), arthritis that is persistent (ie, minimal improvement within 7 d of initiating PO therapy with other agents) or recurrent, or for carditis.

Adult

2 g IV qd
Early disseminated disease and late disease, persistent or recurrent arthritis, carditis: Treat for 14-21 d
Meningitis or encephalitis: Treat for 21 d

Pediatric

75-100 mg/kg/d IV; not to exceed 2 g/d
Early disseminated disease and late disease, persistent or recurrent arthritis, carditis: Treat for 14-21 d
Meningitis or encephalitis: Treat for 21 d

Probenecid may increase ceftriaxone levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Adjust dose in renal impairment; caution in breastfeeding women and allergy to penicillin


Penicillin (Pfizerpen)

Same as ceftriaxone. Administer for CNS infection, persistent or recurrent arthritis, and carditis.

Adult

200,000-300,000 U/kg/d IV; not to exceed 20 million U/d
Early disseminated disease and late disease, persistent or recurrent arthritis, carditis: Treat for 14-21 d
Meningitis or encephalitis: Treat for 21 d

Pediatric

300,000 U/kg/d IV divided q4h; not to exceed 20 million U/d
Early disseminated disease and late disease, persistent or recurrent arthritis, carditis: Treat for 14-21 d
Meningitis or encephalitis: Treat for 21 d

Probenecid can increase effects of penicillin; coadministration of tetracyclines can decrease effects of penicillin

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution in impaired renal function

More on Lyme Disease

Overview: Lyme Disease
Differential Diagnoses & Workup: Lyme Disease
Treatment & Medication: Lyme Disease
Follow-up: Lyme Disease
Multimedia: Lyme Disease
References
Further Reading
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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. Halperin JJ, Shapiro ED, Logigian E, Belman AL, Dotevall L, Wormser GP. 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].

  5. The ILADS Working Group. Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti Infect Ther. 2004;2(1 Suppl):S1-13.

  6. Wormser GP, Dattwyler RJ, Shapiro ED, 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].

  7. Afzelius A. Erythema chronicum migrans. Acta Derm Venereol. 1921;2:120-125.

  8. Avery RA, Frank G, Glutting JJ, Eppes SC. Prediction of Lyme meningitis in children from a Lyme disease-endemic region: a logistic-regression model using history, physical, and laboratory findings. Pediatrics. Jan 2006;117(1):e1-7. [Medline].

  9. Christen HJ, Hanefeld F, Eiffert H, Thomssen R. Epidemiology and clinical manifestations of Lyme borreliosis in childhood. A prospective multicentre study with special regard to neuroborreliosis. Acta Paediatr Suppl. Feb 1993;386:1-75. [Medline].

  10. Cook SP, Macartney KK, Rose CD, Hunt PG, Eppes SC, Reilly JS. Lyme disease and seventh nerve paralysis in children. Am J Otolaryngol. Sep-Oct 1997;18(5):320-3. [Medline].

  11. Edlow JA. Lyme disease and related tick-borne illnesses. Ann Emerg Med. Jun 1999;33(6):680-93. [Medline].

  12. Gerber MA, Zemel LS, Shapiro ED. Lyme arthritis in children: clinical epidemiology and long-term outcomes. Pediatrics. Oct 1998;102(4 Pt 1):905-8. [Medline].

  13. Halsey NA, Abramson JS, Chesney PJ. American Academy of Pediatrics. Committee on Infecious Diseases. Prevention of Lyme disease. Pediatrics. Jan 2000;105(1 Pt 1):142-7. [Medline].

  14. Kaplan RF, Trevino RP, Johnson GM, et al. Cognitive function in post-treatment Lyme disease: do additional antibiotics help?. Neurology. Jun 24 2003;60(12):1916-22. [Medline].

  15. Krupp LB, Hyman LG, Grimson R, et al. Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology. Jun 24 2003;60(12):1923-30. [Medline].

  16. Masuzawa T. Terrestrial distribution of the Lyme borreliosis agent Borrelia burgdorferi sensu lato in East Asia. Jpn J Infect Dis. Dec 2004;57(6):229-35. [Medline].

  17. Moses JM, Riseberg RS, Mansbach JM. Lyme disease presenting with persistent headache. Pediatrics. Dec 2003;112(6 Pt 1):e477-9. [Medline].

  18. Nadelman RB, Nowakowski J, Fish D, et al. Prophylaxis with single-dose doxycycline for the prevention of Lyme disease after an Ixodes scapularis tick bite. N Engl J Med. Jul 12 2001;345(2):79-84. [Medline].

  19. Seltzer EG, Shapiro ED, Gerber MA. Long-term outcomes of lyme disease. JAMA. Jun 21 2000;283(23):3068-9. [Medline].

  20. Shapiro ED. Lyme disease. Pediatr Rev. May 1998;19(5):147-54. [Medline].

  21. Steere AC. Lyme borreliosis in 2005, 30 years after initial observations in Lyme Connecticut. Wien Klin Wochenschr. Nov 2006;118(21-22):625-33. [Medline].

  22. Steere AC. Lyme disease. N Engl J Med. Jul 12 2001;345(2):115-25. [Medline].

  23. Vázquez M, Sparrow SS, Shapiro ED. Long-term neuropsychologic and health outcomes of children with facial nerve palsy attributable to Lyme disease. Pediatrics. Aug 2003;112(2):e93-7. [Medline].

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Keywords

lyme borreliosis, Borrelia burgdorferi, B burgdorferi, Ixodes scapularis, deer tick, tickbite, tick bite, tick-borne illness, Lyme arthritis, Lyme disease, Lyme meningitis, Ixodid ticks, erythema migrans, EM, aseptic meningitis, cranioneuropathies, Bell palsy, encephalitis, carditis, rash, treatment, diagnosis, skin rash, meningismus

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Contributor Information and Disclosures

Author

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.

Coauthor(s)

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.

Medical Editor

Gary J Noel, MD, Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University
Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

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: None None None

 
 
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