Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis
Guidelines by the Infectious Diseases Society of America
[Source / cid.oxfordjournals.org/] ou [Copie locale]
Early Lyme Disease :Erythema migrans.
The recommended for the treatment of adult patients with early
localized or early disseminated Lyme disease associated with
erythema migrans, in the absence of specific neurologic manifestations (see Lyme meningitis, below) or advanced atrioventricular heart block (A-I).
---- Doxycycline (100 mg twice per day),(range, 14 days
---- Amoxicillin (500 mg 3 times per day), 14-21 days
---- cefuroxime axetil (500 mg twice per day) 14-21 days
Cas particuliers (cf infra)
---- Amoxicillin–clavulanic
---- Ceftriaxone
Each of these antimicrobial agents
has been shown to be highly effective for the treatment of
erythema migrans and associated symptoms in prospective
studies.
Doxycycline has the advantage of being effective for
treatment of HGA (but not for babesiosis), which may occur
simultaneously with early Lyme disease. Doxycycline is relatively
contraindicated during pregnancy or lactation and in
children !8 years of age.
Antibiotics recommended for children
are amoxicillin (50 mg/kg per day in 3 divided doses [maximum
of 500 mg per dose]), cefuroxime axetil (30 mg/kg per day in
2 divided doses [maximum of 500 mg per dose]), or, if the
patient is 8 years of age, doxycycline (4 mg/kg per day in 2
divided doses [maximum of 100 mg per dose]) (A-II).
Macrolide antibiotics are not recommended as first-line therapy
for early Lyme disease, because those macrolides that have
been compared with other antimicrobials in clinical trials have
been found to be less effective (E-I). When used, they should
be reserved for patients who are intolerant of, or should not
take, amoxicillin, doxycycline, and cefuroxime axetil.
For adults
with these limitations, recommended dosage regimens for macrolide
antibiotics are as follows: azithromycin, 500 mg orally
per day for 7–10 days; clarithromycin, 500 mg orally twice per
day for 14–21 days (if the patient is not pregnant); or erythromycin,
500 mg orally 4 times per day for 14–21 days.
The
recommended dosages of these agents for children are as follows:
azithromycin, 10 mg/kg per day (maximum of 500 mg
per day); clarithromycin, 7.5 mg/kg twice per day (maximum
of 500 mg per dose); or erythromycin, 12.5 mg/kg 4 times per
day (maximum of 500 mg per dose). Patients treated with
macrolides should be closely observed to ensure resolution of
the clinical manifestations.
When erythema migrans cannot be reliably distinguished
from community-acquired bacterial cellulitis, a reasonable
approach is to treat with either cefuroxime axetil or
Treatment, and Prevention of Lyme Disease,(dosage of amoxicillin–clavulanic
acid for adults, 500 mg 3 times per day; dosage for children,
50 mg/kg per day in 3 divided doses [maximum of 500 mg per
dose]), because these antimicrobials are generally effective
against both types of infection (A-III).
Ceftriaxone, while effective, is not superior to oral agents
and is more likely than the recommended orally administered
antimicrobials to cause serious adverse effects. Therefore, ceftriaxone
is not recommended for treatment of patients with
early Lyme disease in the absence of neurologic involvement
or advanced atrioventricular heart block (E-I).
Lyme meningitis and other manifestations of early neurologic
Lyme disease. The use of ceftriaxone (2 g once per day
intravenously for 14 days; range, 10–28 days) in early Lyme
disease is recommended for adult patients with acute neurologic
disease manifested by meningitis or radiculopathy (B-I). Parenteral
therapy with cefotaxime (2 g intravenously every 8 h)
or penicillin G (18–24 million U per day for patients with
normal renal function, divided into doses given every 4 h), may
be a satisfactory alternative (B-I).
For patients who are intolerant
of b-lactam antibiotics, increasing evidence indicates that
doxycycline (200–400 mg per day in 2 divided doses orally for
10–28) days may be adequate (B-I). Doxycycline is well absorbed
orally; thus, intravenous administration should only
rarely be needed.
For children, ceftriaxone (50–75 mg/kg per day) in a single
daily intravenous dose (maximum, 2 g) (B-I) is recommended.
An alternative is cefotaxime (150–200 mg/kg per day) divided
into 3 or 4 intravenous doses per day (maximum, 6 g per day)
(B-II) or penicillin G (200,000–400,000 units/kg per day; maximum,
18–24 million U per day) divided into doses given intravenously
every 4 h for those with normal renal function (BI).
Children 8 years of age have also been successfully treated
with oral doxycycline at a dosage of 4–8 mg/kg per day in 2
divided doses (maximum, 100–200 mg per dose) (B-II).
