Lyme Disease
Borrelia burgdorferi
Erythema migrans (early disease):
Doxycycline 4.4mg/kg/day IV/PO div q12h (max 200mg/day) for 10 days
If unable to tolerate Doxycycline, consider Amoxicillin 50mg/kg/day PO div q8h (max 500mg/dose) for 14 days²
Empiric Therapy & Alternative Regimens
Duration of Therapy & Clinical Pearls
Please note, the Red Book recommendation changed in 2019 for children <8 years of age. Recent data suggest that doxycycline is not likely to cause visible teeth staining in children younger than 8 years of age, and that doxycycline can be safely used for durations of 21 days or less without regard to patient age. Patients taking doxycycline should continue to avoid sun exposure secondary to photosensitivity, however.
For management of Extracutaneous Disease (facial palsy, arthritis, atrioventricular block or carditis, or meningitis), please consult Infectious Diseases.