Treatment of Lyme Disease with Erythema Migrans in Children Under Age 9
Clinical Scenario
Age under 9 years
This protocol applies to children under 9 years of age presenting with Lyme disease who have erythema migrans and/or non-focal systemic symptoms such as fever, sweats, or muscle pain — without evidence of focal complications.
Treatment Approach
For children in this age group, oral antibiotic therapy is indicated. The choice of agent and regimen depends on the child's weight, with specific weight thresholds determining which antibiotic is appropriate and whether an alternative is needed.
Full dosing details, weight-based thresholds, duration, contraindications, and the complete decision algorithm are in the structured protocol.
References
DOI: 10.1093/cid/ciaa1215
- Lyme disease without focal symptoms with erythema migrans and/or non-focal symptoms
- For children (under 12) diagnosed with Lyme disease, offer antibiotic treatment according to their symptoms as described in table 2.
- Oral amoxicillin for children 33 kg and under: 30 mg/kg 3 times per day for 21 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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