Clinical Treatment of Erythema Migrans Rash

What to know

People treated with appropriate antibiotics in the early stages of Lyme disease usually recover rapidly and completely. Early diagnosis and proper antibiotic treatment of Lyme disease can help prevent late Lyme disease.

Illustration of erythema migrans on different colored skin tones.

Erythema migrans rash

Treatment regimens listed in the following table are for the erythema migrans rash, the most common manifestation of early Lyme disease. These regimens may need to be adjusted depending on a person's age, medical history, underlying health conditions, pregnancy status, or allergies. Consult an infectious disease specialist regarding individual patient treatment decisions.

Treatment regimens for localized (early) Lyme disease.
Age Category Drug Dosage Maximum Duration, Days* References
Adults Doxycycline
OR		 100 mg, twice per day orally N/A 10-14 1 – 6
Amoxicillin
OR		 500 mg, three times per day orally N/A 14 1, 3, 6
Cefuroxime 500 mg, twice per day orally N/A 14 6, 10, 11
Children Doxycycline
OR		 4.4 mg/kg per day orally, divided into 2 doses 100 mg per dose 10–14 7,9
Amoxicillin
OR		 50 mg/kg per day orally, divided into 3 doses 500 mg per dose 14 7,8
Cefuroxime 30 mg/kg per day orally, divided into 2 doses 500 mg per dose 14 8, 10, 11

*When different durations of antibiotics are shown to be effective for the treatment of Lyme disease, the shorter duration is preferred to minimize adverse effects, including infectious diarrhea and antimicrobial resistance.

NOTE: For people intolerant of amoxicillin, doxycycline, and cefuroxime, the macrolide azithromycin may be used, although it is less effective. People treated with azithromycin should be closely monitored to ensure that symptoms resolve.

References

  1. Kowalski TJ, Tata S, Berth W, et al. . Clin Infect Dis. 2010 Feb 15;50(4):512-20.
  2. Nowakowski J, Nadelman RB, Forseter G, et al. . J Am Acad Dermatol. 1995;32(2 Pt 1):223-227.
  3. Smith RP, Schoen RT, Rahn DW, et al. . Ann Intern Med. 2002;136(6):421-428.
  4. Stupica D, Lusa L, Ruzić-Sabljić E,dt al. . Clin Infect Dis. 2012;55(3):343-350.
  5. Wormser GP, Brady KC, Cho MS, et al. . Diagn Microbiol Infect Dis. 2019;94(2):192-194.
  6. Torbahn G, Hofmann H, Rücker G, et al. . JAMA Dermatology 2018;154(11):1292-1303.
  7. Chason M, Monaghan M, Wang J, et al. . J Ped Infect Dis Soc
  8. Eppes S, Childs J. . Pediatrics 2002; 109:1173-1177.
  9. American Academy of Pediatrics. Red Book, 32nd Ed. 2021. (Lyme Borreliosis, Borrelia burgdorferi sensu lato Infection).
  10. Arnez M, Radsel-Medvescek A, Pleterski-Rigler D, et al. Wien Klin Wochenschr. 1999 Dec 10;111(22-23):916-22.
  11. Cerar D, Cerar T, Ruzić-Sabljić E, et al. Am J Med. 2010 Jan;123(1):79-86.
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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)