[Antibiotherapy for early localized Lyme disease].
OBJECTIVE
The aim of this article is to provide clinicians with guidelines for the antibiotherapy of early-localized Lyme disease. The outcome measures are the clearance of erythema migrans and associated symptoms of early localized Lyme disease and the prevention rate of late complications, with a low risk of adverse effects. Design. The reviewed studies were selected by Medline with the keywords: "erythema migrans, treatment". Sixteen studies comparing treatment or duration of treatment were analyzed.


RESULTS
Amoxicillin, doxycycline, and cefuroxim axetil are equally efficacious for early-localized Lyme disease. Azithromycin is an alternative. Most patients respond completely and less than 10% fail to respond. All antibiotics are associated with a low frequency of adverse effects, with the exception of Jarisch Herxheimer reaction which occurs in about 15% of the patients.


CONCLUSIONS
We recommend treating adults with amoxicillin (50 mg/kg/day in 3 intakes) or doxycycline (100 mg bid) for 14 days (erythema migrans) to 21 days (early localized Lyme disease with associated symptoms). For children, we recommend amoxicillin (50 mg/kg/day in 3 intakes) or doxycycline (4 mg/kg/day in 2 intakes, maximum 100 mg/dose) above 8 years of age. Cefuroxim axetil (500 mg twice daily for adults or 30 mg/kg/day in 2 intakes, maximum 500 mg/dose, for children), and azithromycin (500 mg/day for adults and 20 mg/kg/day for children for 7-10 days) are second line treatment.
Monsel
G
G
Service des maladies infectieuses et tropicales, groupe hospitalier de la Pitié-Salpêtrière, Assistance publique-hôpitaux de Paris, 47-83, boulevard de l'hôpital, 75651 Paris cedex 13, France.
Canestri
A
A
Caumes
E
E
D000900:Anti-Bacterial Agents / Q000145:classification / Q000592:standards / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000145:classification* / Q000188:drug therapy* / Q000503:physiopathology; D008826:Microbial Sensitivity Tests; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy
D000900:Anti-Bacterial Agents