From the Guidelines
Erythema migrans in children is the characteristic rash of early Lyme disease that requires prompt antibiotic treatment, with the recommended first-line therapy being oral doxycycline for all ages, dosed at 4.4 mg/kg/day divided twice daily (maximum 100 mg per dose) for 10-14 days, as recommended by the Infectious Diseases Society of America (IDSA) 1. The diagnosis of erythema migrans is typically made clinically, without the need for laboratory testing, in patients with a history of tick exposure in an endemic area 1. Some key points to consider when treating erythema migrans in children include:
- The use of oral antibiotic therapy with doxycycline, amoxicillin, or cefuroxime axetil, with doxycycline being the preferred first-line agent due to its effectiveness against Lyme disease and other tick-borne illnesses 1.
- The recommended duration of treatment is 10-14 days for doxycycline and 14-21 days for amoxicillin or cefuroxime axetil, with a 10-day course of doxycycline being sufficient in some cases 1.
- For children allergic to doxycycline, alternatives include amoxicillin (50 mg/kg/day divided three times daily, maximum 500 mg per dose) for 14-21 days, or cefuroxime axetil (30 mg/kg/day divided twice daily, maximum 500 mg per dose) for 14-21 days 1.
- Parents should monitor the rash during treatment, which typically begins to fade within days of starting antibiotics, and complete resolution may take weeks, with some children experiencing mild fever, headache, or fatigue that should improve with treatment 1. It's worth noting that while macrolide antibiotics such as azithromycin may be used as an alternative in some cases, they are not recommended as first-line therapy due to their lower efficacy compared to doxycycline and other agents 1.
From the Research
Erythema Migrans in Children
- Erythema migrans is a manifestation of Lyme disease, and its treatment in children is crucial to prevent long-term complications 2, 3, 4, 5, 6.
- The treatment of erythema migrans in children can be accomplished with various antibiotics, including amoxicillin, cefuroxime axetil, and clarithromycin 2, 3, 4.
- A study comparing cefuroxime axetil and amoxicillin in children with early Lyme disease found that both antibiotics were safe and efficacious, with total resolution of erythema migrans in 67% of the amoxicillin group and 92% of the low-dose cefuroxime group 2.
- Another study comparing cefuroxime axetil and phenoxymethyl penicillin in children with solitary erythema migrans found that both antibiotics were equally effective, but cefuroxime axetil had more drug-related adverse effects 3.
- A study comparing clarithromycin and amoxicillin in children with solitary erythema migrans found that both antibiotics were equally effective and safe, with comparable side effects 4.
- Doxycycline is not recommended for routine treatment of young children with erythema migrans due to the potential risk of permanent staining of teeth, although the precise risk is uncertain 5.
- Successful treatment of erythema migrans can be accomplished with 20 days of oral doxycycline, amoxicillin, or cefuroxime axetil, and patients with Lyme arthritis can usually be successfully treated with 28 days of oral doxycycline or amoxicillin 6.
Treatment Options
- Amoxicillin: a commonly used antibiotic for the treatment of erythema migrans in children, with a total resolution of erythema migrans in 67% of patients 2.
- Cefuroxime axetil: an effective antibiotic for the treatment of erythema migrans in children, with total resolution of erythema migrans in 92% of patients 2.
- Clarithromycin: an effective antibiotic for the treatment of erythema migrans in children, with comparable side effects to amoxicillin 4.
- Doxycycline: not recommended for routine treatment of young children with erythema migrans due to the potential risk of permanent staining of teeth 5.
Safety and Efficacy
- Amoxicillin and cefuroxime axetil are safe and efficacious treatments for children with early Lyme disease 2.
- Cefuroxime axetil and phenoxymethyl penicillin are equally effective in the treatment of children with solitary erythema migrans, but cefuroxime axetil has more drug-related adverse effects 3.
- Clarithromycin and amoxicillin are equally effective and safe in the treatment of children with solitary erythema migrans, with comparable side effects 4.