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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Treatment of Lyme disease*

Treatment of Lyme disease*
  Drug Adult dose Pediatric dose Comment
Erythema migrans (early disease)
  DoxycyclineΔ 100 mg orally twice daily for 10 days 4.4 mg/kg/day orally divided twice daily (maximum 100 mg per dose) for 10 days
  • Patients with early disseminated disease who present with multiple erythema migrans lesions are treated the same way as those with a single erythema migrans lesion.
  • For patients unable to tolerate the preferred regimens, alternative treatments include:
    • Azithromycin (in adults: 500 mg orally once daily; in children: 10 mg/kg/day [maximum 500 mg per dose]) for 7 days (range 5 to 10 days); or
    • Clarithromycin (in adults: 500 mg orally twice daily; in children: 15 mg/kg/day divided twice daily [maximum 500 mg per dose]) for 14 to 21 days.
or Amoxicillin 500 mg orally 3 times daily for 14 days 50 mg/kg/day orally divided 3 times daily (maximum 500 mg per dose) for 14 days
or Cefuroxime axetil 500 mg orally twice daily for 14 days 30 mg/kg/day orally divided twice daily (maximum 500 mg per dose) for 14 days
Neurologic disease§
Acute neurologic disease, such as:
  • Cranial nerve palsy (eg, facial nerve palsy)
  • Meningitis
  • Radiculoneuropathy (early disseminated disease)
DoxycyclineΔ 100 mg orally twice daily for 14 to 21 days 4.4 mg/kg/day orally divided twice daily (maximum 100 mg per dose) for 14 to 21 days
  • For patients with isolated facial nerve palsy (eg, no evidence of meningitis or radiculoneuropathy), amoxicillin or cefuroxime is an alternative in patients with contraindications to doxycycline. For patients with other forms of acute neurologic disease, most experts would initiate IV therapy (eg, ceftriaxone) if doxycycline cannot be used.
  • In the United States, most practitioners favor using longer courses of antibiotics (eg, 28 days) for those with evidence of severe neurologic disease.
Severe neurologic disease, including encephalitis Ceftriaxone¥ 2 g IV once daily for 14 to 28 days 50 to 75 mg/kg IV once daily (maximum 2 g per dose) for 14 to 28 days
Carditis
Mild (eg, asymptomatic patients with first-degree atrioventricular block and PR interval <300 milliseconds) DoxycyclineΔ 100 mg orally twice daily for 14 to 21 days 4.4 mg/kg/day orally divided twice daily (maximum 100 mg per dose) for 14 to 21 days  
or Amoxicillin 500 mg orally 3 times daily for 14 to 21 days 50 mg/kg/day orally divided 3 times daily (maximum 500 mg per dose) for 14 to 21 days
or Cefuroxime axetil 500 mg orally twice daily for 14 to 21 days 30 mg/kg/day orally divided twice daily (maximum 500 mg per dose) for 14 to 21 days
More serious disease (eg, symptomatic, second- or third-degree atrioventricular block, first-degree atrioventricular block with PR interval ≥300 milliseconds) Ceftriaxone¥ 2 g IV once daily for 14 to 21 days 50 to 75 mg/kg IV once daily (maximum 2 g per dose) for 14 to 21 days
  • A parenteral antibiotic regimen is recommended for initial treatment for hospitalized patients. IV antibiotics should be continued until high-grade atrioventricular block has resolved and the PR interval has become less than 300 milliseconds. The patient may then be switched to oral therapy to complete a 14- to 21-day course.
  • A temporary pacemaker may be necessary for some patients with carditis.
Arthritis
Initial treatment Doxycycline 100 mg orally twice daily for 28 days ≥8 years: 4.4 mg/kg/day orally divided twice daily (maximum 100 mg per dose) for 28 days
  • Cefuroxime is a suitable alternative in patients with contraindications to doxycycline and amoxicillin, although it has not been assessed in clinical studies for this indication.
or Amoxicillin 500 mg orally 3 times daily for 28 days 50 mg/kg/day orally divided 3 times daily (maximum 500 mg per dose) for 28 days
Persistent arthritis with little or no response to oral antibiotics (despite adequate prior oral therapy) Ceftriaxone¥ 2 g IV once daily for 14 to 28 days 50 to 75 mg/kg IV once daily (maximum 2 g per dose) for 14 to 28 days
  • IV therapy should be administered to patients who presented with moderate-to-severe arthritis and had minimal or no response to oral therapy.
  • Retreatment with a second course of oral therapy can be used for those with persistent arthritis who initially presented with mild arthritis (even if there is a minimal response to therapy) as well as those with moderate-to-severe disease who had a partial response to oral therapy. If there is an incomplete response after the second course of oral treatment, then IV therapy should be administered.
  • For patients who fail to respond to oral and IV therapy, the use of disease-modifying antirheumatic drugs or arthroscopic synovectomy may be indicated.
or Doxycycline 100 mg orally twice daily for 28 days ≥8 years: 4.4 mg/kg/day orally divided twice daily (maximum 100 mg per dose) for 28 days
or Amoxicillin 500 mg orally 3 times daily for 28 days 50 mg/kg/day orally divided 3 times daily (maximum 500 mg per dose) for 28 days
Acrodermatitis chronica atrophicans
  Doxycycline 100 mg orally twice daily for 21 to 28 days 4.4 mg/kg/day orally divided twice daily (maximum 100 mg per dose) for 21 to 28 days  
or Amoxicillin 500 mg orally 3 times daily for 21 to 28 days 50 mg/kg/day orally divided 3 times daily (maximum 500 mg per dose) for 21 to 28 days  
or Cefuroxime 500 mg orally twice daily for 21 to 28 days 30 mg/kg/day orally divided twice daily (maximum 500 mg per dose) for 21 to 28 days  
This table is meant for use with UpToDate content on Lyme disease. Refer to UpToDate content for additional details on management of special populations (eg, pediatric and pregnant patients) and management of those with persistent symptoms after treatment.

IV: intravenous.

* A complete response to treatment may be delayed beyond the treatment duration, regardless of the clinical manifestation of Lyme disease. However, in most patients with persistent symptoms the duration of treatment should not be extended.

¶ For pregnant and lactating patients, tetracyclines are generally avoided in favor of a beta-lactam (eg, amoxicillin, cefuroxime). In the setting of neurologic disease or contraindication to a beta-lactam, the decision to use doxycycline must be decided on a case-by-case basis. Although most tetracyclines are contraindicated in pregnancy because of the risk of hepatotoxicity in the mother and potential adverse effects on fetal bone and teeth, limited data suggest these events are extremely rare with doxycycline when short courses are used.

Δ Doxycycline also has activity against coinfections such as Anaplasma phagocytophilum and Borrelia miyamotoi but not against Babesia microti.

◊ The American Academy of Pediatrics supports the use of doxycycline for children <8 years of age if it is administered for ≤21 days. However, the data on safety of doxycycline in this population are limited, and some providers still prefer a beta-lactam rather than doxycycline unless there is evidence of neurologic disease or infection with Anaplasma. Studies have not evaluated the safety of doxycycline in children <8 years of age when the duration of treatment is >21 days (eg, Lyme arthritis).

§ For patients with neurologic disease, there are no studies to help guide length of therapy within the range suggested by the guidelines, and there are no diagnostic tests to determine clearance of infection or predict the success of therapy.

¥ Alternative IV agents include cefotaxime 2 g IV every 8 hours for 14 to 28 days for adults and 150 to 200 mg/kg/day in 3 divided doses (maximum 6 g per day) for children, or penicillin G 18 to 24 million units per day divided into doses given every 4 hours in adults and 200,000 to 400,000 units/kg/day divided every 4 hours (maximum 18 to 24 million units per day) in children.

‡ Doxycycline can be used in patients intolerant of beta-lactam antibiotics.

† On rare occasion, patients may present with late-stage neurologic disease and arthritis. In this setting, IV therapy is usually preferred for initial treatment.
Adapted from:
  1. Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Arthritis Rheumatol 2021; 73:12.
  2. Sanchez E, Vannier E, Wormser GP, Hu LT, et al. Diagnosis, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: a review. JAMA 2016; 315:1767.
  3. American Academy of Pediatrics. Lyme disease. In: Red Book: 2018 Report of the Committee on Infectious Diseases, 31st ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, 2018. p.515.
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