Summary of the 2006 Infectious Diseases Society of America guideline for treatment of Lyme disease (3)
| Clinical stage | Treatment and duration |
|---|---|
| Early localized (e.g., erythema migrans) | First choice: doxycycline 100 mg PO BID, 10–21 d First alternative: amoxicillin 500 mg PO TID, 14–21 d Second alternative: cefuroxime axetil 500 mg PO TID, 14–21 d |
| Early disseminated | |
| MEM, first-degree AVB, facial paralysis | Same as early localized stage |
| Second- and third-degree AVB, meningitis | First choice: ceftriaxone 2 g IV daily, 14–28 d First alternative: penicillin G, 5 million units IV QID, 14–28 d Second alternative: doxycycline 100 mg PO TID, 14–28 d |
| Late disseminated (first episode of arthritis or recurrent arthritis and chronic atrophic acrodermatitis) | First choice: doxycycline 100 mg PO BID, 28 d First alternative: amoxicillin 500 mg PO QID, 28 d Second alternative: penicillin G, 5 million units IV QID, 14–28 d Third alternative: ceftriaxone 2 g IV daily, 14–28 d |
Note: AVB = atrioventricular block, BID = twice per day, IV = intravenous, MEM = multiple erythema migrans, PO = by mouth, QID = 4 times per day, TID = 3 times per day.