From the Guidelines
For children with Lyme disease, amoxicillin is the preferred antibiotic treatment, with a recommended dosage of 50 mg/kg per day in 3 divided doses (maximum, 500 mg per dose). When considering the treatment of Lyme disease in kids, several factors such as the stage and severity of the infection, patient age, and potential side effects of the medication must be taken into account 1. The Infectious Diseases Society of America recommends amoxicillin as a first-line treatment for children due to its efficacy and safety profile 1. Key points to consider when treating Lyme disease in children include:
- The dosage and duration of treatment, which may vary depending on the stage and severity of the infection, with typical treatment courses ranging from 10-21 days 1.
- Alternative antibiotics, such as cefuroxime axetil, may be used if amoxicillin is not suitable, with a recommended dosage of 30 mg/kg per day in 2 divided doses (maximum, 500 mg per dose) 1.
- Doxycycline, although effective, is generally not recommended for children under 8 years of age due to potential side effects, but recent guidelines suggest its use may be considered in certain cases, with a recommended dosage of 4 mg/kg per day in 2 divided doses (maximum, 100 mg per dose) 1. It is essential to start treatment as soon as possible to prevent the progression of the disease to more severe manifestations, such as carditis or neurological complications 1. Parents should ensure that their children complete the full course of antibiotics, even if symptoms improve quickly, to prevent recurrence and ensure effective treatment 1.
From the Research
Antibiotic Treatment for Lyme Disease in Children
- The most effective antibiotic for treating Lyme disease in children is a topic of ongoing research, with several studies investigating the efficacy and safety of different antibiotics 2, 3, 4, 5, 6.
- Amoxicillin is commonly used to treat erythema migrans in the first stage of Lyme disease in children, with a recommended dose of 50 mg/kg/day, administered three times a day (q8h) or twice daily (q12h) with a dose of 25 mg/kg/dose 2.
- Doxycycline is considered an effective treatment for Lyme disease in young children, although concerns about dental staining have limited its use in the past 3.
- A network meta-analysis of 31 randomized controlled trials found that oral amoxicillin, oral azithromycin, injectable ceftriaxone, and injectable cefotaxime were effective for treating Lyme disease, while cefuroxime and penicillin were safe for treating the disease 4.
- Other studies have found that doxycycline, amoxicillin, and cefuroxime axetil are effective treatments for Lyme disease in children, with intravenous ceftriaxone being the accepted standard for parenteral therapy 5, 6.
Comparison of Antibiotics
- Amoxicillin and doxycycline are both effective treatments for Lyme disease in children, although amoxicillin may be preferred in young children due to concerns about dental staining with doxycycline 3, 5.
- Cefuroxime axetil is an alternative to amoxicillin and doxycycline, although its efficacy and safety have not been as extensively studied 5, 6.
- Intravenous ceftriaxone is effective for treating late or severe Lyme disease, although its use is typically reserved for cases that do not respond to oral antibiotics 5, 6.
Treatment Recommendations
- The choice of antibiotic for treating Lyme disease in children should be based on the stage and severity of the disease, as well as the child's age and medical history 2, 3, 4, 5, 6.
- Amoxicillin is a reasonable first-line treatment for early localized Lyme disease, while doxycycline may be preferred for early disseminated or late disease 3, 5.
- Intravenous ceftriaxone should be reserved for cases of late or severe Lyme disease that do not respond to oral antibiotics 5, 6.