How is ECM treated

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 CategoryDrugDosageMaximumDuration (days)
AdultsDoxycycline100 mg, twice per day orallyN/A10–21 a
Cefuroxime axetil500 mg, twice per day orallyN/A14–21
Amoxicillin500 mg, thrice per day orallyN/A14–21
ChildrenAmoxicillin50 mg/kg per day orally, divided into three doses500 mg/dose14–21
Doxycycline4 mg/kg per day orally, divided into two doses100 mg/dose10–21 a
Cefuroxime axetil30 mg/kg per day orally, divided into two doses500 mg/dose14–21

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.


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