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Author: MA Goldstein and CL Harden

Seizures associated with Lyme disease are treated via routine antiepileptic management principles.

Antibiotic treatment regimens for Lyme disease vary according to stage and differ for adults and children:

Lyme disease stage Treatment options
Erythema migrans and systemic symptoms
  Adults
  • Amoxicillin 500 mg p.o. probenecid 500 mg t.i.d. 2–4 wks
  • Doxycycline 100 mg b.i.d. 2–4 wks
  • Cefuroxime 500 mg b.i.d.2–4 wks
  Children
  • Amoxicillin 25–50 mg/kg/day 2–4 wks
  • Erythromycin 30 mg/kg/day 2–4 wks
  • Cefuroxime 250 mg b.i.d.2–4 wks
Early neurologic involvement
  Facial palsy alone Oral antibiotics, same treatment as above
  All others
    Adults
  • Ceftriaxone 2 g/day i.v 2–4 wks
  • Cefotaxime 2 g i.v. t.i.d.2–4 wks
  • Penicillin G 20 million U/day i.v.10–14 days
  • Doxycycline 100 mg p.o. b.i.d.2–4 wks
    Children
  • Ceftriaxone 75–100 mg/kg i.v. 2–4 wks
  • Penicillin G 300,000 U/kg/day i.v. 10–14 days
Late neurologic involvement
  Adults
  • Penicillin, ceftriaxone, or cefotaxime i.v., same treatment as for early involvement
  • Doxycycline 100–200 mg p.o. b.i.d. 30 days
  Children
  • Penicillin or ceftriaxone i.v., same treatment as for early involvement

Antibiotic treatment regimens Table adapted from L Reik. Lyme Disease. In WM Scheld, RJ Whitley, DT Durack (eds), Infections of the Central Nervous System. Philadelphia: Lippincott–Raven, 1997;685–718; DW Rahn, MW Felz. Lyme disease update. Postgraduate Medicine 1998;103:51–70; JR Miller. Spirochete Infections: Lyme Disease. In LP Rowland (ed), Merritt’s Textbook of Neurology. Baltimore: Williams & Wilkins, 1995;209–211.
Adapted from: Goldstein MA and Harden CL. Infectious states. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;83-133.
With permission from Elsevier (www.elsevier.com).
Reviewed and revised March 2004 by Steven C. Schachter, MD, epilepsy.com Editorial Board.