Persistent Lyme Arthritis

Consult Infectious Diseases and Rheumatology

For persistent arthritis after first course of therapy for patients who have responded incompletely or who respond and then relapse soon after stopping therapy.

Infection Prevention and Control

Routine Practices

Most Likely Pathogen

Borellia burgdorferi

Duration of therapy

28 days

Suggested Regimen

Less than 8 years of age:
Amoxicillin 16 mg/kg/dose PO TID
Maximum: 500 mg/dose

There is limited safety data on the use of doxycycline for greater than 21 days in children less than 8 years of age

Greater than or equal to 8 years of age:
Doxycycline 2.2 mg/kg/dose PO BID
[Round dose to nearest 25 mg (1/4 tablet)]
Maximum: 100 mg/dose

Penicillin Allergy

Cefuroxime 15 mg/kg/dose PO BID
Maximum: 500 mg/dose

For patients who experience worsening of their arthritis

Ceftriaxone 50-75 mg/kg/dose IV q24h x 14 - 28 days
Maximum: 2000 mg /dose