How is ECM treated
In adults and children (≥8 years), doxycycline is the drug of choice. Doxycycline has good penetration into the central nervous system (CNS) and is also effective against coinfection with Anaplasma (see Question 23). In younger children and in pregnant or lactating women, amoxicillin and cefuroxime axetil should be used. See table for dosing regimens. Treatment will shorten the duration of ECM and greatly reduces the occurrence of later manifestations of Lyme disease.
| Age Category | Drug | Dosage | Maximum | Duration (days) |
|---|---|---|---|---|
| Adults | Doxycycline | 100 mg, twice per day orally | N/A | 10–21 a |
| Cefuroxime axetil | 500 mg, twice per day orally | N/A | 14–21 | |
| Amoxicillin | 500 mg, thrice per day orally | N/A | 14–21 | |
| Children | Amoxicillin | 50 mg/kg per day orally, divided into three doses | 500 mg/dose | 14–21 |
| Doxycycline | 4 mg/kg per day orally, divided into two doses | 100 mg/dose | 10–21 a | |
| Cefuroxime axetil | 30 mg/kg per day orally, divided into two doses | 500 mg/dose | 14–21 |
Note: For patients with an allergy or intolerance to amoxicillin, doxycycline and/or cefuroxime axetil, the macrolides (azithromycin, clarithromycin, or erythromycin) may be used. The macrolides have lower efficacy, however, and patients treated with this regimen should be monitored closely for resolution of symptoms.
a Recent publications suggest the efficacy of shorter courses of treatment for early Lyme disease.
