Lyme disease
ICD-10 A69.2 · ICD-11 1C1G

Treatment of Lyme Disease Presenting with Erythema Migrans

This protocol addresses Lyme disease in patients who present with erythema migrans — the characteristic skin lesion that may appear as a solitary or multiple rash — and for whom specific antibiotic tolerability constraints apply.

Clinical Scenario

The patient has Lyme disease with erythema migrans skin lesion (solitary or multiple). Oral antibiotic therapy is the recommended approach for this presentation, guided by individual patient tolerability and contraindications.

Treatment Approach (Partial Overview)

When patients are unable to tolerate certain first-line antibiotic classes, a macrolide antibiotic may be selected as a second-line option for a defined course.

Agent selection criteria, duration, and full dosing guidance are available in the complete structured protocol.

Instant Access to Structured Evidence-Based Regimens

References

  1. For patients with erythema migrans, we recommend using oral antibiotic therapy with doxycycline, amoxicillin, or cefuroxime axetil (strong recommendation, moderate-quality evidence).
  2. For patients unable to take both doxycycline and beta-lactam antibiotics, the preferred second-line agent is azithromycin.
  3. If azithromycin is used, the indicated duration is 5–10 days, with a 7-day course preferred in the United States, as this duration of therapy was used in the largest clinical trial performed in the United States.
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