Treatment of Lyme Disease with Erythema Migrans or Non-Focal Symptoms in Patients Aged 9 and Over
Clinical Scenario
This protocol addresses Lyme disease presenting without focal organ involvement, where the clinical picture is defined by erythema migrans and/or constitutional non-focal symptoms such as fever, sweats, and muscle pain. Patient age — specifically 9 years and over — is a defining criterion for this treatment approach.
Patient Population
Lyme disease without focal symptoms but with erythema migrans and/or non-focal symptoms. For adults and young people aged 9 and over, antibiotic treatment is indicated and is selected according to the clinical presentation, age, weight, and relevant contraindications.
Treatment Approach
First-line management consists of an oral antibiotic course. Agent choice and duration depend on patient age and weight, and certain cardiac considerations influence which options are appropriate. The complete structured regimen — including agent selection, dosing by age and weight tier, and specific contraindications — is available in the full protocol.
References
DOI: 10.1093/cid/ciaa1215
- Lyme disease without focal symptoms but with erythema migrans and/or non-focal symptoms
- For adults and young people (aged 12 and over) diagnosed with Lyme disease, offer antibiotic treatment according to their symptoms as described in table 1.
- Oral doxycycline: 100 mg twice per day or 200 mg once per day for 21 days
- Oral doxycycline for children under 45 kg: 5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days
- Oral amoxicillin: 1 g 3 times per day for 21 days
- Oral amoxicillin for children 33 kg and under: 30 mg/kg 3 times per day for 21 days
- Oral azithromycin: 500 mg daily for 17 days
- Oral azithromycin for children 50 kg and under: 10 mg/kg daily for 17 days
- Note: Do not use azithromycin to treat people with cardiac abnormalities associated with Lyme disease because of its effect on QT interval.
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