From the Guidelines
For pediatric patients with Lyme disease, doxycycline is dosed at 4 mg/kg per day in 2 divided doses (maximum of 100 mg per dose), given orally, for children aged 8 years and older. The dosage for children under 8 years is not recommended due to the potential risk of dental staining, although recent guidelines suggest that the risk may be minimal with short courses 1. The duration of treatment depends on the stage and manifestation of Lyme disease: early localized disease (including single erythema migrans) requires 10-14 days of treatment, while early disseminated or late disease may require 14-21 days.
- Doxycycline is considered acceptable for children of all ages with Lyme disease, as the risk of dental staining with short courses is minimal compared to the benefit of effective treatment 1.
- Common side effects include photosensitivity and gastrointestinal upset, so the medication should be taken with food and sun protection should be used.
- If neurologic involvement, cardiac manifestations, or arthritis are present, treatment duration or medication choice may need adjustment based on severity 1.
- For children 8 years and older, the dosage of doxycycline is 4 mg/kg per day in 2 divided doses (maximum of 100 mg per dose), which is supported by the Infectious Diseases Society of America guidelines 1.
From the Research
Pediatric Doxycycline Dose for Lyme
- The recommended dose of doxycycline for children with Lyme disease varies by age and weight, with a maximum dose of 100 mg per dose 2.
- For children above 8 years of age, doxycycline can be used at a dose of 4 mg/kg/day in 2 intakes, with a maximum dose of 100 mg/dose 2.
- A study published in 2023 found that doxycycline is generally well-tolerated and effective in treating Lyme disease in young children, with a dose of 4.4 mg/kg per day (maximum 100 mg per dose) for 10-14 days 3.
- Another study published in 2024 found that doxycycline use in children under 8 years old increased over the study period, with 67.9% of children receiving doxycycline in 2023, and the dose used was not specified 4.
- A network meta-analysis published in 2021 did not find significant evidence of the efficacy and safety of doxycycline for treating Lyme disease in children or adults, but this may be due to limited data 5.
- The American Academy of Pediatrics recommends that up to 3 weeks or less of doxycycline is safe in children of all ages 4.
Key Considerations
- Doxycycline is considered a first-line treatment for Lyme disease in adolescents and adults, but its use in children under 8 years old has been limited due to concerns about tooth staining 3.
- Alternative antibiotics, such as amoxicillin, may be preferred for treating non-neurological Lyme disease manifestations in young children, but doxycycline may be a safe and effective alternative when needed 3.
- Prospective studies are needed to confirm the safety and efficacy of doxycycline in children younger than 8 years, especially for those receiving courses longer than 3 weeks 4.