How are second and late stages of Lyme disease treated

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 ManifestationAntibioticTreatment Duration in Days (range)
Second Stage (Disseminated Disease)
Meningitis or radiculopathyCeftriaxone 2 g intravenous (IV) daily (pediatric dosage 50–75 mg/kg IV daily) b14 (10–28)
Cefotaxime 2 g IV every 8 hours (pediatric dosage 150–200 mg/kg daily in 3–4 divided doses) b14 (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) c14 (10–28)
Isolated facial nerve palsySame oral antibiotics as used in the treatment of erythema migrans14 (14–21)
Carditis eCeftriaxone 2 g IV daily (pediatric dosage 50–75 mg/kg IV daily) initially for hospitalized patients14 (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)
ArthritisSame oral antibiotics as used in the treatment of erythema migrans28
If no response to oral antibiotics, re-treat with either another course of oral antibiotics or with ceftriaxone28 with oral antibiotics
14–28 with ceftriaxone
Encephalomyelitis or peripheral neuropathyCeftriaxone 2 g IV daily (pediatric dosage 50–75 mg/kg IV daily) b14–28
Cefotaxime 2 g IV every 8 hours (pediatric dosage 150–200 mg/kg daily in 3–4 divided doses) b14–28
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.

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