Template:ID-Lyme neuroborreliosis: Difference between revisions

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* Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines<ref>{{Cite journal| doi = 10.1086/508667| issn = 1537-6591| volume = 43| issue = 9| pages = 1089–1134| last1 = Wormser| first1 = Gary P.| last2 = Dattwyler| first2 = Raymond J.| last3 = Shapiro| first3 = Eugene D.| last4 = Halperin| first4 = John J.| last5 = Steere| first5 = Allen C.| last6 = Klempner| first6 = Mark S.| last7 = Krause| first7 = Peter J.| last8 = Bakken| first8 = Johan S.| last9 = Strle| first9 = Franc| last10 = Stanek| first10 = Gerold| last11 = Bockenstedt| first11 = Linda| last12 = Fish| first12 = Durland| last13 = Dumler| first13 = J. Stephen| last14 = Nadelman| first14 = Robert B.| title = The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2006-11-01| pmid = 17029130}}</ref>
*1. '''Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines'''<ref>{{Cite journal| doi = 10.1086/508667| issn = 1537-6591| volume = 43| issue = 9| pages = 1089–1134| last1 = Wormser| first1 = Gary P.| last2 = Dattwyler| first2 = Raymond J.| last3 = Shapiro| first3 = Eugene D.| last4 = Halperin| first4 = John J.| last5 = Steere| first5 = Allen C.| last6 = Klempner| first6 = Mark S.| last7 = Krause| first7 = Peter J.| last8 = Bakken| first8 = Johan S.| last9 = Strle| first9 = Franc| last10 = Stanek| first10 = Gerold| last11 = Bockenstedt| first11 = Linda| last12 = Fish| first12 = Durland| last13 = Dumler| first13 = J. Stephen| last14 = Nadelman| first14 = Robert B.| title = The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2006-11-01| pmid = 17029130}}</ref>
:* Early neurologic disease
:*1.1 '''Early neurologic disease'''
::* '''Cranial nerve palsy (adult)'''
::*1.1.1 '''Cranial nerve palsy (adult)'''
:::* Preferred regimen: [[Amoxicillin]] 500 mg PO tid for 14 (14–21) days {{or}} [[Doxycycline]] 100 mg PO bid for 14 (14–21) days {{or}} [[Cefuroxime]] 500 mg PO bid for 14 (14–21) days
:::* Preferred regimen (1): [[Amoxicillin]] 500 mg PO tid for 14 (14–21) days
:::* Alternative regimen: [[Azithromycin]] 500 mg PO qd for 7–10 days {{or}} [[Clarithromycin]] 500 mg PO bid for 14–21 days (not for pregnant) {{or}} [[Erythromycin]] 500 mg PO qid for 14–21 days


::* '''Cranial nerve palsy (pediatric)'''
:::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 14 (14–21) days
:::* Preferred regimen: [[Amoxicillin]] 50 mg/kg/day PO in 3 divided doses, max 500 mg/dose for 14 (14–21) days {{or}} [[Doxycycline]] (for children aged ≥ 8 years) 4 mg/kg/day PO q12h, max 100 mg/dose for 14 (14–21) days {{or}} [[Cefuroxime]] 30 mg/kg/day PO q12h, max 500 mg/dose for 14 (14–21) days
:::* Alternative regimen: [[Azithromycin]] 10 mg/kg/day PO, max 500 mg/dose for 7–10 days {{or}} [[Clarithromycin]] 7.5 mg/kg PO bid, max 500 mg/dose for 14–21 days {{or}} [[Erythromycin]] 12.5 mg/kg PO aid, max 500 mg/dose for 14–21 days


::* '''Meningitis or radiculopathy (adult)'''
:::* Preferred regimen (3): [[Cefuroxime]] 500 mg PO bid for 14 (14–21) days
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days.
:::* Alternative regimen (1): [[Azithromycin]] 500 mg PO qd for 7–10 days
:::* Alternative regimen: [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days {{or}} [[Penicillin G]] 18–24 MU/day IV q4h for 14 (10–28) days
:::: Note: for nonpregnant adult patients intolerant of β-lactam agents, [[Doxycycline]] 200–400 mg/day PO/IV q12h may be considered.


::* '''Meningitis or radiculopathy (pediatric)'''
:::* Alternative regimen (2): [[Clarithromycin]] 500 mg PO bid for 14–21 days (not for pregnant)  
:::* Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h, max 2 g/day for 14 (10–28) days
:::* Alternative regimen: [[Cefotaxime]] 150–200 mg/kg/day IV in 3–4 divided doses, max 6 g/day for 14 (10–28) days {{or}} [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day for 14 (10–28) days
:::: Note: for children ≥ 8 years of age intolerant of β-lactam agents, [[Doxycycline]] 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day may be considered.


:* Late neurologic disease
:::* Alternative regimen (3): [[Erythromycin]] 500 mg PO qid for 14–21 days
::* '''Central or peripheral nervous system disease (adult)'''
 
::*1.1.2 '''Cranial nerve palsy (pediatric)'''
:::* Preferred regimen (1): [[Amoxicillin]] 50 mg/kg/day PO tid (Maxmum, 500 mg/dose) for 14 (14–21) days
 
:::* Preferred regimen (2): [[Doxycycline]] (for children aged ≥ 8 years) 4 mg/kg/day PO q12h (Maxmum, 100 mg/dose) for 14 (14–21) days 
 
:::* Preferred regimen (3): [[Cefuroxime]] 30 mg/kg/day PO q12h (Maxmum, 500 mg/dose) for 14 (14–21) days
:::* Alternative regimen (1): [[Azithromycin]] 10 mg/kg/day PO (Maxmum, 500 mg/dose) for 7–10 days
 
:::* Alternative regimen (2): [[Clarithromycin]] 7.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days
 
:::* Alternative regimen (3): [[Erythromycin]] 12.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days
 
::*1.1.3 '''Meningitis or radiculopathy (adult)'''
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days
:::* Alternative regimen: [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days {{or}} [[Penicillin G]] 18–24 MU/day IV q4h for 14 (10–28) days
:::* Alternative regimen (1): [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days
 
:::* Alternative regimen (2): [[Penicillin G]] 18–24 MU/day IV q4h for 14 (10–28) days
:::* Note: for nonpregnant adult patients intolerant of β-lactam agents, [[Doxycycline]] 200–400 mg/day PO/IV q12h may be considered.
 
::*1.1.4 '''Meningitis or radiculopathy (pediatric)'''
:::* Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days
:::* Alternative regimen (1): [[Cefotaxime]] 150–200 mg/kg/day IV q6-8h (Maxmum, 6 g/day) for 14 (10–28) days 
 
:::* Alternative regimen (2): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
:::* Note: for children ≥ 8 years of age intolerant of β-lactam agents, [[Doxycycline]] 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day may be considered
 
:*1.2 '''Late neurologic disease'''
::*1.2.1 '''Central or peripheral nervous system disease (adult)'''
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days
:::* Alternative regimen (1): [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days 
 
:::* Alternative regimen (2): [[Penicillin G]] 18–24 MU/day IV q4h for 14 (10–28) days
 
::*1.2.2 '''Central or peripheral nervous system disease (pediatric)'''
:::* Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days.
:::* Alternative regimen (1): [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h (Maxmum, 6 g/day) for 14 (10–28) days  


::* '''Central or peripheral nervous system disease (pediatric)'''
:::* Alternative regimen (2): [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
:::* Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h, max 2 g for 14 (10–28) days.
:::* Alternative regimen: [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day for 14 (10–28) days {{or}} [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day for 14 (10–28) days


* American Academy of Neurology (AAN) Practice Parameter<ref>{{Cite journal| doi = 10.1212/01.wnl.0000265517.66976.28| issn = 1526-632X| volume = 69| issue = 1| pages = 91–102| last1 = Halperin| first1 = J. J.| last2 = Shapiro| first2 = E. D.| last3 = Logigian| first3 = E.| last4 = Belman| first4 = A. L.| last5 = Dotevall| first5 = L.| last6 = Wormser| first6 = G. P.| last7 = Krupp| first7 = L.| last8 = Gronseth| first8 = G.| last9 = Bever| first9 = C. T.| last10 = Quality Standards Subcommittee of the American Academy of Neurology| title = Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology| journal = Neurology| date = 2007-07-03| pmid = 17522387}}</ref>
*2. '''American Academy of Neurology (AAN) Practice Parameter'''<ref>{{Cite journal| doi = 10.1212/01.wnl.0000265517.66976.28| issn = 1526-632X| volume = 69| issue = 1| pages = 91–102| last1 = Halperin| first1 = J. J.| last2 = Shapiro| first2 = E. D.| last3 = Logigian| first3 = E.| last4 = Belman| first4 = A. L.| last5 = Dotevall| first5 = L.| last6 = Wormser| first6 = G. P.| last7 = Krupp| first7 = L.| last8 = Gronseth| first8 = G.| last9 = Bever| first9 = C. T.| last10 = Quality Standards Subcommittee of the American Academy of Neurology| title = Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology| journal = Neurology| date = 2007-07-03| pmid = 17522387}}</ref>
:* '''Meningitis'''
:*2.1 '''Meningitis'''
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Alternative regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Alternative regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Pediatric dose: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
::* Pediatric regimen: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day


:* '''Any neurologic syndrome with CSF pleocytosis'''
:*2.2 '''Any neurologic syndrome with CSF pleocytosis'''
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day IV q4h for 14 days
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day IV q4h for 14 days
::* Alternative regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Alternative regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Pediatric dose: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
::* Pediatric regimen: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day


:* '''Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)'''
:*2.3 '''Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)'''
::* Preferred regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Preferred regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Alternative regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day IV q4h for 14 days
::* Alternative regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day IV q4h for 14 days
::* Pediatric dose: [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
::* Pediatric regimen: [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day


:* '''Encephalomyelitis'''
:*2.4 '''Encephalomyelitis'''
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Pediatric dose: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
::* Pediatric regimen: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day


:* '''Encephalopathy'''
:*2.5 '''Encephalopathy'''
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Pediatric dose: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
::* Pediatric regimen: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day


:* '''Post-treatment Lyme syndrome'''
:*2.6 '''Post-treatment Lyme syndrome'''
::* Preferred regimen: symptomatic management
::* Preferred regimen: symptomatic management
::: Note: Antibiotic therapy is not indicated.
::* Note: Antibiotic therapy is not indicated.

Revision as of 14:34, 29 July 2015

  • 1. Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines[1]
  • 1.1 Early neurologic disease
  • 1.1.1 Cranial nerve palsy (adult)
  • Preferred regimen (1): Amoxicillin 500 mg PO tid for 14 (14–21) days
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 14 (14–21) days
  • Preferred regimen (3): Cefuroxime 500 mg PO bid for 14 (14–21) days
  • Alternative regimen (1): Azithromycin 500 mg PO qd for 7–10 days
  • Alternative regimen (2): Clarithromycin 500 mg PO bid for 14–21 days (not for pregnant)
  • Alternative regimen (3): Erythromycin 500 mg PO qid for 14–21 days
  • 1.1.2 Cranial nerve palsy (pediatric)
  • Preferred regimen (1): Amoxicillin 50 mg/kg/day PO tid (Maxmum, 500 mg/dose) for 14 (14–21) days
  • Preferred regimen (2): Doxycycline (for children aged ≥ 8 years) 4 mg/kg/day PO q12h (Maxmum, 100 mg/dose) for 14 (14–21) days
  • Preferred regimen (3): Cefuroxime 30 mg/kg/day PO q12h (Maxmum, 500 mg/dose) for 14 (14–21) days
  • Alternative regimen (1): Azithromycin 10 mg/kg/day PO (Maxmum, 500 mg/dose) for 7–10 days
  • Alternative regimen (2): Clarithromycin 7.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days
  • Alternative regimen (3): Erythromycin 12.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days
  • 1.1.3 Meningitis or radiculopathy (adult)
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days
  • Alternative regimen (1): Cefotaxime 2 g IV q8h for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days
  • Note: for nonpregnant adult patients intolerant of β-lactam agents, Doxycycline 200–400 mg/day PO/IV q12h may be considered.
  • 1.1.4 Meningitis or radiculopathy (pediatric)
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days
  • Alternative regimen (1): Cefotaxime 150–200 mg/kg/day IV q6-8h (Maxmum, 6 g/day) for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
  • Note: for children ≥ 8 years of age intolerant of β-lactam agents, Doxycycline 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day may be considered
  • 1.2 Late neurologic disease
  • 1.2.1 Central or peripheral nervous system disease (adult)
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days
  • Alternative regimen (1): Cefotaxime 2 g IV q8h for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days
  • 1.2.2 Central or peripheral nervous system disease (pediatric)
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days.
  • Alternative regimen (1): Cefotaxime 150–200 mg/kg/day IV q6–8h (Maxmum, 6 g/day) for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
  • 2. American Academy of Neurology (AAN) Practice Parameter[2]
  • 2.1 Meningitis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 2.2 Any neurologic syndrome with CSF pleocytosis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day IV q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 2.3 Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)
  • Preferred regimen: Doxycycline 100–200 mg BID for 14 days
  • Alternative regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day IV q4h for 14 days
  • Pediatric regimen: Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 2.4 Encephalomyelitis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
  • 2.5 Encephalopathy
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
  • 2.6 Post-treatment Lyme syndrome
  • Preferred regimen: symptomatic management
  • Note: Antibiotic therapy is not indicated.
  1. ↑ Wormser, Gary P.; Dattwyler, Raymond J.; Shapiro, Eugene D.; Halperin, John J.; Steere, Allen C.; Klempner, Mark S.; Krause, Peter J.; Bakken, Johan S.; Strle, Franc; Stanek, Gerold; Bockenstedt, Linda; Fish, Durland; Dumler, J. Stephen; Nadelman, Robert B. (2006-11-01). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 43 (9): 1089–1134. doi:10.1086/508667. ISSN 1537-6591. PMID 17029130.
  2. ↑ Halperin, J. J.; Shapiro, E. D.; Logigian, E.; Belman, A. L.; Dotevall, L.; Wormser, G. P.; Krupp, L.; Gronseth, G.; Bever, C. T.; Quality Standards Subcommittee of the American Academy of Neurology (2007-07-03). "Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 69 (1): 91–102. doi:10.1212/01.wnl.0000265517.66976.28. ISSN 1526-632X. PMID 17522387.
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