Treatment

Treatment of early Lyme disease in adults includes doxycy-cline, 100 mg twice daily, or amoxicillin, 500 mg three times daily, for 21 days. Amoxicillin is first-line therapy in children less than 8 years old; cefuroxime axetil or erythromycin is used in cases of doxycycline or amoxicillin allergy (Worsmer et al., 2006). Oral therapy is as effective as IV therapy for patients with either early Lyme disease or Lyme arthritis and is less costly (Eckman et al., 1997). Concern about the risk of late neurologic sequelae should not lead to more aggressive treatment with IV antibiotics for these patients (Wormser et al., 2000). Early treatment prevents recurrent arthritis as well as neurologic and cardiac sequelae. IV therapy with ceftriaxone (Rocephin), cefotaxime (Claforan), or penicillin G is used for early disseminated and late Lyme disease. IV antibiotic therapy is preferable for patients with neurologic symptoms, with the possible exception of those with facial palsy alone (Steere, 1989). Most patients are symptomati-cally better with 20 days of treatment. Continued symptomatology in patients with treated infection does not respond to further antibiotics (Klippel, 2001). Antibiotic treatment failures can occur but are rare and usually associated with poor absorption. Antibiotic resistance to typically used agents has not been shown.

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