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Last Updated: 1/23/2013  

Lyme Disease

Prevention
  • Urge patients to avoid exposure to vector ticks in endemic areas and to promptly remove attached ticks.

  • Do not routinely use antibiotics or serologic testing for the prevention of Lyme disease after a tick bite.

Diagnosis
  • Use serologic testing to confirm the diagnosis of Lyme disease in suspected cases; understand that serologic testing is not needed to establish the diagnosis in patients with a history of tick exposure in an endemic area presenting with erythema migrans.

  • Obtain a Western blot only in patients with indeterminate or positive ELISA or IFA results.

Therapy
  • Treat erythema migrans with oral doxycycline or amoxicillin for 14 days.

  • In patients with Lyme disease and neurologic involvement, treat those with meningitis or radiculopathy with parenteral ceftriaxone and treat those with cranial nerve palsy with standard oral regimens.

  • Use oral (generally doxycycline) or parenteral (ceftriaxone) antibiotic therapy for patients with cardiac Lyme disease.

  • Treat patients with Lyme arthritis with doxycycline for 28 days; treat those with arthritis and neurologic disease with ceftriaxone.

DOI: 10.7326/d091
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Authors and Disclosures:
Daniel W. Rahn, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Gary Wormser, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. John J. Halperin, MD, FAAN, FACP receives royalties from a book, "Lyme Disease - An Evidence-Based Approach".

The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, FACP, Editor.

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