Template:ID-Lyme neuroborreliosis

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  • 1. Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines[1]
  • 1.1 Early neurologic disease
  • 1.1.1 Cranial nerve palsy (adult)
  • Preferred regimen (1): Amoxicillin 500 mg PO tid for 14 (14–21) days
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 14 (14–21) days
  • Preferred regimen (3): Cefuroxime 500 mg PO bid for 14 (14–21) days
  • Alternative regimen (1): Azithromycin 500 mg PO qd for 7–10 days
  • Alternative regimen (2): Clarithromycin 500 mg PO bid for 14–21 days (not for pregnant)
  • Alternative regimen (3): Erythromycin 500 mg PO qid for 14–21 days
  • 1.1.2 Cranial nerve palsy (pediatric)
  • Preferred regimen (1): Amoxicillin 50 mg/kg/day PO tid (Maxmum, 500 mg/dose) for 14 (14–21) days
  • Preferred regimen (2): Doxycycline (for children aged ≥ 8 years) 4 mg/kg/day PO q12h (Maxmum, 100 mg/dose) for 14 (14–21) days
  • Preferred regimen (3): Cefuroxime 30 mg/kg/day PO q12h (Maxmum, 500 mg/dose) for 14 (14–21) days
  • Alternative regimen (1): Azithromycin 10 mg/kg/day PO (Maxmum, 500 mg/dose) for 7–10 days
  • Alternative regimen (2): Clarithromycin 7.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days
  • Alternative regimen (3): Erythromycin 12.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days
  • 1.1.3 Meningitis or radiculopathy (adult)
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days
  • Alternative regimen (1): Cefotaxime 2 g IV q8h for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days
  • Note: for nonpregnant adult patients intolerant of β-lactam agents, Doxycycline 200–400 mg/day PO/IV q12h may be considered.
  • 1.1.4 Meningitis or radiculopathy (pediatric)
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days
  • Alternative regimen (1): Cefotaxime 150–200 mg/kg/day IV q6-8h (Maxmum, 6 g/day) for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
  • Note: for children ≥ 8 years of age intolerant of β-lactam agents, Doxycycline 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day may be considered
  • 1.2 Late neurologic disease
  • 1.2.1 Central or peripheral nervous system disease (adult)
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days
  • Alternative regimen (1): Cefotaxime 2 g IV q8h for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days
  • 1.2.2 Central or peripheral nervous system disease (pediatric)
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days.
  • Alternative regimen (1): Cefotaxime 150–200 mg/kg/day IV q6–8h (Maxmum, 6 g/day) for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
  • 2. American Academy of Neurology (AAN) Practice Parameter[2]
  • 2.1 Meningitis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 2.2 Any neurologic syndrome with CSF pleocytosis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day IV q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 2.3 Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)
  • Preferred regimen: Doxycycline 100–200 mg BID for 14 days
  • Alternative regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day IV q4h for 14 days
  • Pediatric regimen: Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 2.4 Encephalomyelitis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
  • 2.5 Encephalopathy
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
  • 2.6 Post-treatment Lyme syndrome
  • Preferred regimen: symptomatic management
  • Note: Antibiotic therapy is not indicated.

References

  1. ↑ Wormser, Gary P.; Dattwyler, Raymond J.; Shapiro, Eugene D.; Halperin, John J.; Steere, Allen C.; Klempner, Mark S.; Krause, Peter J.; Bakken, Johan S.; Strle, Franc; Stanek, Gerold; Bockenstedt, Linda; Fish, Durland; Dumler, J. Stephen; Nadelman, Robert B. (2006-11-01). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 43 (9): 1089–1134. doi:10.1086/508667. ISSN 1537-6591. PMID 17029130.
  2. ↑ Halperin, J. J.; Shapiro, E. D.; Logigian, E.; Belman, A. L.; Dotevall, L.; Wormser, G. P.; Krupp, L.; Gronseth, G.; Bever, C. T.; Quality Standards Subcommittee of the American Academy of Neurology (2007-07-03). "Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 69 (1): 91–102. doi:10.1212/01.wnl.0000265517.66976.28. ISSN 1526-632X. PMID 17522387.
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