Table: Guidelines for Antibiotic Treatment of Lyme Disease in Adults*-Merck Manual Professional Edition

Guidelines for Antibiotic Treatment of Lyme Disease in Adults*

Drug	Dosage
Early Lyme disease†
	500 mg orally 3 times a day for 14 days
	100 mg orally twice a day for 10 days
	500 mg orally twice a day for 14 days
	500 mg orally once a day for 7 days
Neurologic manifestations
Bell palsy (no other neurologic abnormalities):
	100 mg orally twice a day for 14–21 days
Meningitis (with or without radiculoneuropathy or encephalitis)‡:
	2 g IV once a day for 14–21 days
	2 g IV every 8 hours for 14–21 days
	3–4 million units IV every 4 hours for 14–21 days
	100–200 mg orally twice a day for 14–21 days
Cardiac manifestations
	2 g IV once a day for 14–21 days
	3–4 million units IV every 4 hours for 14–21 days
	100 mg orally twice a day for 14–21 days§
	500 mg orally 3 times a day for 14–21 days§
	500 mg orally 2 times a day for 14–21 days§
Arthritis (no neurologic involvement)║
	500 mg orally 3 times a day for 28 days
	100 mg orally twice a day for 28 days
	500 mg orally twice a day for 28 days
	2 g IV once a day for 28 days
Acrodermatitis chronica atrophicans
	500 mg orally 3 times a day for 21–28 days
	100 mg orally twice a day for 21–28 days
	500 mg orally 2 times a day for 21–28 days

† Without neurologic, cardiac, or joint involvement. For early Lyme disease limited to a single erythema migrans lesion, 10 days is sufficient.
‡ Optimal duration of therapy has not been established. There are no controlled trials of therapy > 4 weeks for any neurologic manifestation of Lyme disease.
§ For mild carditis with 1st-degree heart block in which PR interval is < 300 milliseconds, and ventricular function is normal.

Adapted from Lantos PM, Rumbaugh J, Bockenstedt LK, et al: Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis 72(1):e1–e48, 2021. doi: 10.1093/cid/ciaa1215

Drug

Dosage

Early Lyme disease†

500 mg orally 3 times a day for 14 days

100 mg orally twice a day for 10 days

500 mg orally twice a day for 14 days

500 mg orally once a day for 7 days

Neurologic manifestations

Bell palsy (no other neurologic abnormalities):

100 mg orally twice a day for 14–21 days

Meningitis (with or without radiculoneuropathy or encephalitis)‡:

2 g IV once a day for 14–21 days

2 g IV every 8 hours for 14–21 days

3–4 million units IV every 4 hours for 14–21 days

100–200 mg orally twice a day for 14–21 days

Cardiac manifestations

2 g IV once a day for 14–21 days

3–4 million units IV every 4 hours for 14–21 days

100 mg orally twice a day for 14–21 days§

500 mg orally 3 times a day for 14–21 days§

500 mg orally 2 times a day for 14–21 days§

Arthritis (no neurologic involvement)║

500 mg orally 3 times a day for 28 days

100 mg orally twice a day for 28 days

500 mg orally twice a day for 28 days

2 g IV once a day for 28 days

Acrodermatitis chronica atrophicans

500 mg orally 3 times a day for 21–28 days

100 mg orally twice a day for 21–28 days

500 mg orally 2 times a day for 21–28 days

† Without neurologic, cardiac, or joint involvement. For early Lyme disease limited to a single erythema migrans lesion, 10 days is sufficient.

‡ Optimal duration of therapy has not been established. There are no controlled trials of therapy > 4 weeks for any neurologic manifestation of Lyme disease.

§ For mild carditis with 1st-degree heart block in which PR interval is < 300 milliseconds, and ventricular function is normal.

Adapted from Lantos PM, Rumbaugh J, Bockenstedt LK, et al: Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the prevention, diagnosis and treatment of Lyme disease. Clin Infect Dis 72(1):e1–e48, 2021. doi: 10.1093/cid/ciaa1215