Antibiotic Treatment for Lyme Disease

Treatment Duration and Antibiotic Selection

The recommended duration of antibiotic treatment for early localized or early disseminated Lyme disease with erythema migrans is 14 days (range 10-21 days), and 28 days for Lyme arthritis, according to the Infectious Diseases Society of America 1, 2, 3
Doxycycline is recommended for 10-21 days (typically 14 days) for early localized or early disseminated Lyme disease, and amoxicillin or cefuroxime axetil for 14-21 days 1, 2
For children under 8 years, amoxicillin is recommended for 14 days or cefuroxime axetil for 14 days 4
Oral antibiotics (doxycycline, amoxicillin, or cefuroxime axetil) are recommended for 28 days for Lyme arthritis 5, 3
Intravenous ceftriaxone (2g once daily) is recommended for 2-4 weeks for neurologic Lyme disease 5, 3

Macrolide antibiotics (azithromycin, clarithromycin) are less effective than doxycycline or amoxicillin and should only be used when first-line agents cannot be tolerated 1, 3
The Infectious Diseases Society of America strongly recommends against long-term antibiotic therapy, combination antimicrobials, and other unproven approaches due to lack of efficacy and potential for harm 3

First-line options for adults include doxycycline (100mg twice daily), amoxicillin (500mg three times daily), or cefuroxime axetil (500mg twice daily) 1, 2, 3
Second-line options include azithromycin, clarithromycin, or erythromycin, but should only be used when first-line agents cannot be tolerated 1
Using first-generation cephalosporins, fluoroquinolones, carbapenems, vancomycin, metronidazole, or tinidazole is ineffective against B. burgdorferi and should be avoided 3, 4