Guidelines for Antibiotic Treatment of Lyme Disease in Adults*
Medication | Dosage |
|---|---|
Early Lyme disease† | |
AmoxicillinAmoxicillin | 500 mg orally 3 times a day for 14 days |
DoxycyclineDoxycycline | 100 mg orally twice a day for 10 days |
Cefuroxime axetilCefuroxime axetil | 500 mg orally twice a day for 14 days |
Azithromycin (for patients unable to take doxycycline or beta-lactam antibiotics)Azithromycin (for patients unable to take doxycycline or beta-lactam antibiotics) | 500 mg orally once a day for 7 days |
Neurologic manifestations | |
Bell palsy (no other neurologic abnormalities): | |
DoxycyclineDoxycycline | 100 mg orally twice a day for 14–21 days |
Meningitis (with or without radiculoneuropathy or encephalitis)‡: | |
CeftriaxoneCeftriaxone | 2 g IV once a day for 14–21 days |
CefotaximeCefotaxime | 2 g IV every 8 hours for 14–21 days |
Penicillin GPenicillin G | 3–4 million units IV every 4 hours for 14–21 days |
Doxycycline (for early neurologic disease)Doxycycline (for early neurologic disease) | 100–200 mg orally twice a day for 14–21 days |
Cardiac manifestations | |
CeftriaxoneCeftriaxone | 2 g IV once a day for 14–21 days |
Penicillin GPenicillin G | 3–4 million units IV every 4 hours for 14–21 days |
Doxycycline§Doxycycline§ | 100 mg orally twice a day for 14–21 days§ |
Amoxicillin§Amoxicillin§ | 500 mg orally 3 times a day for 14–21 days§ |
Cefuroxime§Cefuroxime§ | 500 mg orally 2 times a day for 14–21 days§ |
Arthritis (no neurologic involvement)║ | |
AmoxicillinAmoxicillin | 500 mg orally 3 times a day for 28 days |
DoxycyclineDoxycycline | 100 mg orally twice a day for 28 days |
Cefuroxime axetilCefuroxime axetil | 500 mg orally twice a day for 28 days |
CeftriaxoneCeftriaxone | 2 g IV once a day for 14–28 days |
Acrodermatitis chronica atrophicans | |
AmoxicillinAmoxicillin | 500 mg orally 3 times a day for 21–28 days |
DoxycyclineDoxycycline | 100 mg orally twice a day for 21–28 days |
CefuroximeCefuroxime | 500 mg orally 2 times a day for 21–28 days |
* Pregnant women may receive amoxicillin 500 mg 3 times a day for 14 days. No treatment is necessary for pregnant patients who are seropositive but asymptomatic.* Pregnant women may receive amoxicillin 500 mg 3 times a day for 14 days. No treatment is necessary for pregnant patients who are seropositive but asymptomatic. | |
† Without neurologic, cardiac, or joint involvement. For early Lyme disease limited to a single erythema migrans lesion, 10 days is sufficient. | |
‡ Optimal duration of therapy has not been established. There are no controlled trials of therapy > 4 weeks for any neurologic manifestation of Lyme disease. | |
§ For mild carditis with first-degree heart block in which PR interval is < 300 milliseconds, and ventricular function is normal. | |
║ Treatment begins with an oral regimen, which is repeated if response is inadequate. If there was no response or symptoms worsen, parenteral ceftriaxone is given.║ Treatment begins with an oral regimen, which is repeated if response is inadequate. If there was no response or symptoms worsen, parenteral ceftriaxone is given. | |
Adapted from Lantos PM, Rumbaugh J, Bockenstedt LK, et al: Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis 72(1):e1–e48, 2021. doi: 10.1093/cid/ciaa1215 | |