Initial Treatment of Lyme Disease in Children

Duration of Treatment

The Infectious Diseases Society of America (IDSA) recommends a treatment duration of 14 days for amoxicilina, according to the 2020 guidelines 1
The acceptable range for amoxicilina is 14-21 days, but 14 days is sufficient for most cases 4
A duration of 14 days is specific to beta-lactam antibiotics like amoxicilina due to their shorter half-life, compared to doxycycline which can be administered for only 10 days 1

The American Academy of Pediatrics recommends a pediatric dosage of 50 mg/kg/day divided into 3 daily doses (every 8 hours), with a maximum of 500 mg per dose 1
For a 6-year-old child, amoxicilina is the appropriate first-line antibiotic, as doxycycline is traditionally avoided in children under 8 years old 5

Multiple prospective randomized clinical trials have demonstrated comparable efficacy between the three first-line regimens (doxycycline, amoxicilina, cefuroxime axetil), with complete response rates above 83% at 30 months 2

No laboratory tests are required to diagnose erythema migrans in endemic areas when the clinical presentation is typical; the diagnosis is clinical 1
The treatment should not be extended beyond 21 days, as there is no evidence to support greater efficacy with longer courses 5
Amoxicilina should be administered with food to reduce gastrointestinal intolerance 2

Never use first-generation cephalosporins (such as cephalexin), as they are completely inactive against Borrelia burgdorferi 2
Macrolide antibiotics (azithromycin, clarithromycin, erythromycin) are less effective than first-line agents and should only be reserved for patients intolerant to all first-line options 2
Do not confuse the treatment duration: 10 days is sufficient only for doxycycline, while 14 days is necessary for amoxicilina and cefuroxime axetil 1