Spectrum: Local Antimicrobial Stewardship, for CHEO-OCTC

Persistent Lyme Arthritis

For persistent arthritis after first course of therapy

Infection Prevention and Control

Routine Practices

Most Likely Pathogen

Borellia burgdorferi

Suggested Regimen

Doxycycline 4.4 mg/kg/24h PO divided q12h
Maximum: 200mg/24h

There are limited safety data on the use of doxycycline for > 21 days in children < 8 years of age

OR

Amoxicillin 50 mg/kg/24h PO divided q8h
Maximum: 1.5 gram/24h

Penicillin Allergy

Cefuroxime 30 mg/kg/24h PO divided q12h
Maximum: 1 gram /24h

If unable to take a beta-lactam or doxycycline

Azithromycin 10 mg/kg/day PO once daily but this is considered second or third line therapy as it is less efficacious

Duration of therapy

28 days

**In consultation with Infectious Diseases**

Ceftriaxone 50-75 mg/kg/day IV once daily for 14 days
Maximum: 2 gram /24h