Clinical features

Drug, route of administration (choose one)

Dosage

Treatment duration (days)

Tick bite where rate of tick infections is <10% and/or tick was on for <24 h

Monitoringb

– Erythema migrans

– Borrelial lymphocytoma

– Cranial neuritisc (palsy)

Doxycycline,b PO

100 mg bid or 200 mg once daily

14-21

Amoxicillin, PO

500-1000 mg tid (children 50 mg/kg/d)

14-21

Cefuroxime axetil, PO

500 mg bid (children 30 mg/kg/d)

14-21

Arthritis (first episode)

Doxycycline, PO

100 mg bid or 200 mg once daily

14-28

Amoxicillin, PO

500-1000 mg tid (children 50 mg/kg/d)

14-28

Cefuroxime axetil, PO

500 mg bid (children 30 mg/kg/d)

14-28

– Neuroborreliosis

– Arthritis (relapse)

– Carditis

Ceftriaxone, IV

2000 mg once daily (children 50-75 mg/kg/d)

14-28

Cefotaxime, IV

2000 mg tid (children 150-200 mg/kg/d in 3-4 divided doses)

14-28

Acrodermatitis chronica atrophicans

Doxycycline, PO

100 mg bid or 200 mg once daily

14-28

Amoxicillin, PO

500-1000 mg tid

14-28

Ceftriaxone, IV

2000 mg once daily

14-28

Cefotaxime, IV

2000 mg tid

14-28

a Based on guidelines from the Infectious Diseases Society of America and the Polish Society of Epidemiology and Infectious Diseases (2020).

b Tetracyclines are contraindicated in pregnancy and for children aged <8 years. Macrolides are considered third-line therapy and should be reserved for patients with contraindications to both beta-lactams and doxycycline.

c Evaluate for signs and symptoms of meningitis.