How are second and late stages of Lyme disease treated
How should the second (disseminated disease) and third (late disease) stages of Lyme disease be treated?
Disease Manifestation | Antibiotic | Treatment Duration in Days (range) |
---|---|---|
Second Stage (Disseminated Disease) | ||
Meningitis or radiculopathy | Ceftriaxone 2 g intravenous (IV) daily (pediatric dosage 50–75 mg/kg IV daily) a , b | 14 (10–28) |
Cefotaxime 2 g IV every 8 hours (pediatric dosage 150–200 mg/kg daily in 3–4 divided doses) b | 14 (10–28) | |
Penicillin G 18–24 million U IV daily divided every 4 hours (pediatric dosage 200–400k U/kg daily divided every 4 hours) | 14 (10–28) | |
Doxycycline 100 mg orally twice daily (pediatric dosage for children aged ≥8 years 4–8 mg/kg daily divided in 2 doses) c | 14 (10–28) | |
Isolated facial nerve palsy | Same oral antibiotics as used in the treatment of erythema migrans | 14 (14–21) |
Carditis d , e | Ceftriaxone 2 g IV daily (pediatric dosage 50–75 mg/kg IV daily) initially for hospitalized patients | 14 (14–21) |
Same oral antibiotics as used in the treatment of erythema migrans (outpatients or for the remainder of treatment in hospitalized patients) | 14 (14–21) | |
Third Stage (Late Disease) | ||
Arthritis | Same oral antibiotics as used in the treatment of erythema migrans | 28 |
If no response to oral antibiotics, re-treat with either another course of oral antibiotics or with ceftriaxone | 28 with oral antibiotics 14–28 with ceftriaxone | |
Encephalomyelitis or peripheral neuropathy | Ceftriaxone 2 g IV daily (pediatric dosage 50–75 mg/kg IV daily) a , b | 14–28 |
Cefotaxime 2 g IV every 8 hours (pediatric dosage 150–200 mg/kg daily in 3–4 divided doses) b | 14–28 | |
Penicillin G 18–24 million U IV daily divided every 4 hours (pediatric dosage 200–400k U/kg daily divided every 4 hours) | 14–28 |
a Preferred in adults.
b Preferred in children.
c For patients who are intolerant to beta lactams.
d Hospitalization and continuous cardiac monitoring in patients with chest pain, dyspnea, syncope, first-degree heart block with PR interval ≥30 ms, second- or third-degree heart block.
e Advanced heart block may require a temporary pacemaker.