From the Guidelines
For children with Lyme disease, the recommended antibiotics include amoxicillin, cefuroxime axetil, or doxycycline for children 8 years and older, with treatment duration usually ranging from 14-28 days depending on the stage and manifestation of the disease. The choice of antibiotic depends on the child's age and the specific manifestation of the disease.
- For children under 8 years old, amoxicillin (50 mg/kg per day divided into three doses, maximum 500 mg per dose) is the preferred treatment option 1.
- For children 8 years and older, doxycycline (4 mg/kg per day divided into two doses, maximum 100 mg per dose) is recommended 1.
- Cefuroxime axetil (30 mg/kg per day divided into two doses, maximum 500 mg per dose) is an alternative option for children of all ages 1. The treatment duration varies depending on the stage and manifestation of the disease:
- Early localized or early disseminated Lyme disease without neurological involvement: 14-21 days 1.
- Lyme arthritis: 28-day course 1.
- Lyme carditis or neurological Lyme: 14-28 days of treatment 1. It's essential to start treatment promptly after diagnosis to prevent progression to later stages of the disease. These antibiotics work by disrupting bacterial cell wall formation or protein synthesis, effectively eliminating the Borrelia burgdorferi bacteria that causes Lyme disease. Parents should complete the full course of antibiotics even if symptoms improve, monitor for side effects, and follow up with healthcare providers to ensure the infection has resolved completely 1.
From the FDA Drug Label
For children above eight years of age: The recommended dosage schedule for children weighing 100 pounds or less is 2 mg/lb of body weight divided into two doses on the first day of treatment, followed by 1 mg/lb of body weight given as a single daily dose or divided into two doses, on subsequent days.
The therapeutic antibacterial serum activity will usually persist for 24 hours following recommended dosage.
When used in streptococcal infections, therapy should be continued for 10 days
The dosage of doxycycline for children over 8 years old is 2 mg/lb of body weight on the first day, divided into two doses, followed by 1 mg/lb of body weight per day.
- The treatment duration for streptococcal infections is 10 days. However, the provided drug label does not specifically mention Lyme disease. 2
From the Research
Antibiotics for Lyme Disease in Children
- The recommended dose of amoxicillin for children with Lyme disease is 50 mg/kg/day, administered three times a day (q8h) 3.
- A study found that a twice-daily dosing of 25 mg/kg/dose provides comparable bactericidal activity to the thrice-daily regimen for minimum inhibitory concentrations (MICs) between 0.06 and 1 mg/L 3.
- Doxycycline is the oral antibacterial of choice, while amoxicillin and cefuroxime axetil are alternatives that may be preferred in young children 4.
- Intravenous ceftriaxone has become the accepted standard for parenteral therapy due to its long half-life and once daily dose administration 4.
Effective Antibiotics for Lyme Disease
- Oral amoxicillin (1.5 g/day), oral azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were found to be effective for treating Lyme disease 5.
- Cefuroxime and penicillin were found to be safe for treating Lyme disease 5.
- Amoxicillin was found to be effective for treating erythema migrans (EM) 5.
Treatment and Prophylaxis
- Treatment of Lyme disease is usually accomplished with doxycycline or amoxicillin; cefuroxime axetil or erythromycin can be used as an alternative 6.
- Late or severe disease requires intravenous ceftriaxone or penicillin G 6.
- Single-dose doxycycline (200 mg orally) can be used as prophylaxis in selected patients 6.
- For nervous system Lyme disease, penicillin, ceftriaxone, cefotaxime, and doxycycline are effective antimicrobial agents 7.