Lyme Disease

Infection

Lyme Disease

Possible therapeutic alternatives

Tick Exposure

Borrelia burgdorferi

Prompt tick removal. Single dose doxycycline 200mg if: <72hr in epidemic area (NEJM 2001;345:79)

Prophylactic: Doxycycline 200mg orally x 1 within 72 hours post tick bite - 87% effective, best only in highly endemic region.

Lyme disease - Erythema migrans

Preferred:
Doxycycline 100mg orally twice daily x 10-14 days.

Alternatives:
Amoxicillin 500mg orally three times daily x 14-21 days or
Cefuroxime axetil (Ceftin) 500mg orally twice daily x 14-21 days.

Lyme disease - Early Disseminated or Late complications

Bells palsy:
Doxycycline 100mg orally twice daily x 21-28 days or
Amoxicillin 500mg orally three times daily x 21-28 days.

CNS (other):
Ceftriaxone 2g IV q12h x 14-28 days or
Cefotaxime 2g IV q6h x 14-28 days or
Penicillin G 4 MU IV q 4h x 14-28 days.

Cardiac first degree block:
Doxycycline 100mg orally twice daily x 21-28 days or
Amoxicillin 500mg orally three times daily x 21-28 days.

Arthritis -
oral: Doxycycline 100mg orally twice daily x 28 days or Amoxicillin 500mg orally three times daily x 28 days.

IV: Cefotaxime 2g IV q8h x 14-28 days or Penicillin G 18-24 mil U IV qd x 14-28 days.

Images

Tick bite