<prompt> Answer this question truthfullyWhat is the recommended medical treatment for Lyme disease?  <response>: <reason> Infectious Diseases Society of America IDSA Clinical Practice Guidelines for treatment of Lyme disease 1 Stage 1 - early localized Lyme disease 1.1 Erythema migrans 1.1.1 Adult Preferred regimen 1: Doxycycline 100 mg PO q12h for 10-21 days avoid in pregnancy Preferred regimen 2: Amoxicillin 500 mg PO q8h for 14-21 days Preferred regimen 3: Cefuroxime axetil 500 mg q12h for 14-21 days Alternative regimen 1: Azithromycin 500 mg PO q6h for 710 days Alternative regimen 2: Clarithromycin 500 mg PO q12h for 1421 days avoid in pregnancy Alternative regimen 3: Erythromycin 500 mg PO q6h for 1421 days 1.1.2 Pediatric 1.1.2.1 Children 8 years of age Preferred regimen 1: Amoxicillin 50 mgkg PO per day q8h maximum, 500 mg per dose Preferred regimen 2: Cefuroxime axetil 30 mgkg PO per day in 2 divided doses maximum, 500 mg per dose Alternative regimen 1: Azithromycin 10 mgkg PO q6h maximum, 500 mg per day Alternative regimen 2: Clarithromycin 7.5 mgkg PO q12h maximum, 500 mg per dose Alternative regimen 3: Erythromycin 12.5 mgkg PO q6h maximum, 500 mg per dose 1.1.2.2 Children 8 years of age Preferred regimen 1: Doxycycline 4 mgkgday PO q12h maximum, 100 mg per dose Alternative regimen 1: Azithromycin 10 mgkg PO q6h maximum, 500 mg per day Alternative regimen 2: Clarithromycin 7.5 mgkg PO q12h maximum, 500 mg per dose Alternative regimen 3: Erythromycin 12.5 mgkg PO q6h maximum, 500 mg per dose 2.1 When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis 2.1.1 Adult Preferred regimen 1: Amoxicillin-Clavulanate 500 mg PO q8h 2.1.2 Pediatric Preferred regimen 1: Amoxicillin-Clavulanate 50 mgkgday PO q8h maximum, 500 mg per dose2 Stage 2 - early disseminated Lyme disease 2.1 Lyme carditis Note 1: A parenteral regimen is recommended at the start of therapy for patients who have been hospitalized for cardiac monitoring; oral regimen may be substituted to complete a course of therapy or to treat ambulatory patients. Note 2: A temporary pacemaker may be required for patients with advanced heart block. Note 3: Patients treated with macrolides should be closely observed to ensure resolution of the clinical manifest. 2.1.1 Adult Parenteral regimen Preferred regimen 1: Ceftriaxone 2 g IV q24h for 14 1421 days Alternative regimen 1: Cefotaxime 2 g IV q8h for 14 1421 days Alternative regimen 2: Penicillin G 1824 MUday IV q4h for 14 1421 days patients with normal renal function Oral regimen Preferred regimen 1: Amoxicillin 500 mg PO q8h for 14 1421 days Preferred regimen 2: Doxycycline 100 mg PO q12h for 14 1421 days avoid in pregnancy Preferred regimen 3: Cefuroxime 500 mg PO q12h for 14 1421 days Alternative regimen 1: Azithromycin 500 mg PO q6h for 710 days Alternative regimen 2: Clarithromycin 500 mg PO q12h for 1421 days avoid in pregnancy Alternative regimen 3: Erythromycin 500 mg PO q6h for 1421 days 2.1.2 Pediatric Parenteral regimen Preferred regimen 1: Ceftriaxone 5075 mgkg IV q24h for 14 1421 days maximum, 2 g Alternative regimen 1: Cefotaxime 150200 mgkgday IV q68h for 14 1421 days maximum, 6 g per day Alternative regimen 2: Penicillin G 200,000400,000 Ukgday IV q4h for 14 1421 days maximum, 1824 million U per day patients with normal renal function Oral regimen Preferred regimen 1: Amoxicillin 50 mgkgday PO q8h for 14 1421 days maximum, 500 mg per dose Preferred regimen 2: Doxycycline for children aged 8 years 4 mgkgday PO q12h for 14 1421 days maximum, 100 mg per dose Preferred regimen 3: Cefuroxime 30 mgkgday PO q12h for 14 1421 days maximum, 500 mg per dose Alternative regimen 1: Azithromycin 10 mgkg PO q6h 710 days maximum, 500 mg per day Alternative regimen 2: Clarithromycin 7.5 mgkg PO q12h for 1421 days maximum, 500 mg per dose Alternative regimen 3: Erythromycin 12.5 mgkg PO q6h for 1421 days maximum,500 mg per dose 2.2 Borrelial lymphocytoma The same regimens used to treat patients with erythema migrans see above3 Stage 3 - Late disseminated Lyme Disease 3.1 Lyme arthritis 3.1.1 Adult Preferred regimen 1: Doxycycline 100 mg PO q12h for 28 days avoid in pregnancy Preferred regimen 2: Amoxicillin 500 mg PO q8h for 28 days Preferred regimen 3: Cefuroxime axetil 500 mg PO q12h for 28 days 3.1.2 Pediatric Preferred regimen 1: Amoxicillin 50 mgkgday PO q8h for 28 days maximum, 500 mg per dose Preferred regimen 1: Cefuroxime axetil 30 mgkgday PO q12h for 28 days maximum, 500 mg per dose Preferred regimen 1: Doxycycline for children aged 8 years 4 mgkgday PO q12h for 28 days maximum, 100 mg per dose Note: Patients with persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy are suggested re-treatment with another 4-week course of oral antibiotics or with a 24 week course of ceftriaxone. 3.2 Patients with arthritis and objective evidence of neurologic disease 3.2.1 Adult Preferred regimen 1: Ceftriaxone 2 g IV q24h for 24 weeks Alternative regimen 1: Cefotaxime 2 g IV q8h for 24 weeks Alternative regimen 2: Penicillin G 1824 MUday IV q4h for 2-4 weeks patients with normal renal function 3.2.2 Pediatric Preferred regimen 1: Ceftriaxone 5075 mgkg IV q24h for 24 weeks maximum, 2 g Preferred regimen 1: Cefotaxime 150200 mgkgday IV q68h for 24 weeks maximum, 6 g per day Alternative regimen 1: Penicillin G 200,000400,000 Ukgday IV q4h for 14 for 24 weeks maximum, 1824 million U per day patients with normal renal function 3.3 Acrodermatitis chronica atrophicans Preferred regimen 1: Doxycycline 100 mg PO q12h for 21 days avoid in pregnancy Preferred regimen 2: Amoxicillin 500 mg PO q8h for 21 days Preferred regimen 3: Cefuroxime axetil 500 mg PO q12h for 21 days4. PostLyme Disease Syndromes Preferred regimen: Further antibiotic therapy for Lyme disease should not be given unless there are objective findings of active disease including physical findings, abnormalities on cerebrospinal or synovial fluid analysis, or changes on formal neuropsychologic testing1. Infectious Diseases Society of America IDSA Clinical Practice Guidelines 1.1 Early neurologic disease Stage 2 - early disseminated Lyme disease 1.1.1 Cranial nerve palsy 1.1.1.1 Adult Preferred regimen 1: Amoxicillin 500 mg PO q8h for 14 1421 days Preferred regimen 2: Doxycycline 100 mg PO q12h for 14 1421 days avoid in pregnancy Preferred regimen 3: Cefuroxime 500 mg PO q12h for 14 1421 days Alternative regimen 1: Azithromycin 500 mg PO q6h for 710 days Alternative regimen 2: Clarithromycin 500 mg PO q12h for 1421 days Alternative regimen 3: Erythromycin 500 mg PO q6h for 1421 days 1.1.1.2. Pediatric Preferred regimen 1: Amoxicillin 50 mgkgday PO q8h for 14 1421 days maximum, 500 mgdose Preferred regimen 2: Doxycycline for children aged 8 years 4 mgkgday PO q12h for 14 1421 days maximum, 100 mgdose Preferred regimen 3: Cefuroxime 30 mgkgday PO q12h for 14 1421 days maximum, 500 mgdose Alternative regimen 1: Azithromycin 10 mgkgday PO q6h for 710 days maximum, 500 mgday Alternative regimen 2: Clarithromycin 7.5 mgkg PO q12h for 1421 days maximum, 500 mgdose Alternative regimen 3: Erythromycin 12.5 mgkg PO q12h for 1421 days maximum, 500 mgdose 1.1.2 Meningitis or radiculopathy 1.1.2.1 Adult Preferred regimen 1: Ceftriaxone 2 g IV q24h for 14 1028 days Alternative regimen 1: Cefotaxime 2 g IV q6-8h for 14 1028 days Alternative regimen 2: Penicillin G 1824 MUday IV q4h for 14 1028 days patients with normal renal function Note: For adult patients intolerant of β-lactam agents, doxycycline avoid in pregnancy 200400 mgday POIV q12h may be considered. 1.1.2.2 Pediatric Preferred regimen 1: Ceftriaxone 5075 mgkg IV q24h for 14 1028 days maximum, 2 gday Alternative regimen 1: Cefotaxime 150200 mgkgday IV q6-8h for 14 1028 days maximum, 6 gday Alternative regimen 2: Penicillin G 200,000400,000 Ukgday IV q4h for 14 1028 days maximum, 1824 MUday patients with normal renal function Note: For children intolerant of β-lactam agents, doxycycline children aged 8 years 48 mgkgday POIV q12h maximum, 200400 mgday may be considered 1.2 Late neurologic disease Stage 3 - late disseminated Lyme disease 1.2.1 Central or peripheral nervous system disease 1.2.1.1 Adult Preferred regimen: Ceftriaxone 2 g IV q24h for 14 1028 days Alternative regimen 1: Cefotaxime 2 g IV q8h for 14 1028 days Alternative regimen 2: Penicillin G 1824 MUday IV q4h for 14 1028 days patients with normal renal function 1.2.1.2 Pediatric Preferred regimen: Ceftriaxone 5075 mgkg IV q24h for 14 1028 days maximum, 2 gday Alternative regimen 1: Cefotaxime 150200 mgkgday IV q68h for 14 1028 days maximum, 6 gday Alternative regimen 2: Penicillin G 200,000400,000 Ukgday IV q4h for 14 1028 days maximum, 1824 MUday patients with normal renal function2 American Academy of Neurology AAN Practice Parameter 2.1 Meningitis 2.1.1 Adult Preferred regimen 1: Ceftriaxone 2 g IV q24h for 14 days Preferred regimen 2: Cefotaxime 2 g IV q8h for 14 days Preferred regimen 3: Penicillin G 1824 MUday q4h for 14 days patients with normal renal function Alternative regimen 1: Doxycycline 100200 mg q12h for 14 days avoid in pregnancy 2.1.2 Pediatric Preferred regimen 1: Ceftriaxone 5075 mgkgday IV q24h maximum, 2 gday Preferred regimen 2: Cefotaxime 150200 mgkgday IV q68h maximum, 6 gday Preferred regimen 3: Penicillin G 200,000400,000 Ukgday IV q4h maximum, 1824 MUday patients with normal renal function Alternative regimen 1: Doxycycline for children aged 8 years 48 mgkgday q12h maximum 200 mgday 2.2 Any neurologic syndrome with CSF pleocytosis 2.2.1 Adult Preferred regimen 1: Ceftriaxone 2 g IV q24h for 14 days Preferred regimen 2: Cefotaxime 2 g IV q8h for 14 days Preferred regimen 3: Penicillin G 1824 MUday IV q4h for 14 days patients with normal renal function Alternative regimen 1: Doxycycline 100200 mg q12h for 14 days avoid in pregnancy 2.2.2 Pediatric Preferred regimen 1: Ceftriaxone 5075 mgkgday IV q24h maximum, 2 gday Preferred regimen 2: Cefotaxime 150200 mgkgday IV q68h maximum, 6 gday Preferred regimen 2: Penicillin G 200,000400,000 Ukgday q4h maximum, 1824 MUday patients with normal renal function Alternative regimen 1: Doxycycline for children aged 8 years 48 mgkgday q12h maximum 200 mgday 2.3 Peripheral nervous system disease radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF 2.3.1 Adult Preferred regimen 1: Doxycycline 100200 mg q12h for 14 days avoid in pregnancy Alternative regimen 1: Ceftriaxone 2 g IV q24h for 14 days Alternative regimen 2: Cefotaxime 2 g IV q8h for 14 days Alternative regimen 3: Penicillin G 1824 MUday IV q4h for 14 days patients with normal renal function 2.3.2 Pediatric Preferred regimen 1: Doxycycline for children aged 8 years 48 mgkgday q12h maximum 200 mgday Alternative regimen 1: Ceftriaxone 5075 mgkgday IV q24h maximum, 2 gday Alternative regimen 2: Cefotaxime 150200 mgkgday IV q68h maximum, 6 gday Alternative regimen 3: Penicillin G 200,000400,000 Ukgday IV q4h maximum, 1824 MUday patients with normal renal function 2.4 Encephalomyelitis 2.4.1 Adult Preferred regimen 1: Ceftriaxone 2 g IV q24h for 14 days Preferred regimen 2: Cefotaxime 2 g IV q8h for 14 days Preferred regimen 3: Penicillin G 1824 MUday IV q4h for 14 days patients with normal renal function 2.4.2 Pediatric Preferred regimen 1: Ceftriaxone 5075 mgkgday IV q24h maximum, 2 gday Preferred regimen 2: Cefotaxime 150200 mgkgday IV q68h maximum, 6 gday Preferred regimen 3: Penicillin G 200,000400,000 Ukgday IV q4h maximum, 1824 MUday patients with normal renal function 2.5 Encephalopathy 2.5.1 Adult Preferred regimen 1: Ceftriaxone 2 g IV q24h for 14 days Preferred regimen 2: Cefotaxime 2 g IV q8h for 14 days Preferred regimen 3: Penicillin G 1824 MUday IV q4h for 14 days patients with normal renal function 2.5.2 Pediatric Preferred regimen 1: Ceftriaxone 5075 mgkgday IV q24h maximum, 2 gday Preferred regimen 2: Cefotaxime 150200 mgkgday IV q68h maximum, 6 gday Preferred regimen 3: Penicillin G 200,000400,000 Ukgday IV q4h maximum, 1824 MUday patients with normal renal function 2.6 Post-treatment Lyme syndrome Preferred regimen: symptomatic management Note: Antibiotic therapy is not indicatedApproximately 10 to 20 of patients treated for Lyme disease with a recommended 2-4 week course of antibiotics will develop post-treatment Lyme disease syndrome PTLDS. Patients report lingering symptoms of fatigue, pain, or joint and muscle aches. In some cases, these can last for more than 6 months. The majority of patients with post-treatment Lyme disease syndrome gradually improve over monthsyears of the primary infection. 