SKIN - Lyme Disease, Acute Mild to Moderate (Borrelia burgdorferi)
Amoxicillin (Amoxil^®) Generics available Pregnancy: B; Lactation: Unsafe Caps: 250 mg, 500 mg   Tabs: 500 mg, 875 mg   Chewable Tab: 125 mg, 250 mg, Susp: 125 mg/5 mL, 250 mg/5 mL   Oral drops: 50 mg/mL	Children: 40-50 mg/kg/day (max 1500 mg/day) in divided doses three times daily for 21 days. 250 mg/tsp @ 40 mg/kg/day 10 kg (22 lb) = 3 mL Q8H 15 kg (33 lb) = 1 tsp (5 mL) Q8H 20 kg (44 lb) = 1½ tsp (7.5 mL) Q8H ≥ 30 kg (66 lb) = Use adult dose. Adult: 500 mg PO three times daily for 21 days.	Food: May take with or without meals. Important side effects: Diarrhea and nausea. May cause nonallergic maculopapular rash Reduce dose in renal disease (CrCl <30 mL/min).
Doxycycline (Vibramycin^®) Generics available Pregnancy: D; Lactation: Unsafe Caps: 50 mg, 100 mg	Children: 2-4 mg/kg/day (max 200 mg/day) in 2 divided doses for 21 days. Children ≥8 years and Adult: 100 mg PO twice daily for 21 days.	Food: May take with food if GI upset occurs. Take 1 hour before or 2 hours after antacids, iron, milk, or other dairy products. Take with full glass of water to prevent esophagitis.
Tabs: 50 mg, 100 mg   Oral Susp: 25 mg/5 mL   Syrup: 50 mg/5 mL	A drug of choice, especially for persons intolerant to beta-lactams. Consider in younger children if true beta-lactam allergy. Especially useful if coinfection with ehrlichiosis suspected.	Important side effects: Photosensitivity, (use sunscreen), esophagitis. May discolor fingernails. Low chance of staining teeth in young children, avoid repeated courses.
Cefuroxime axetil (Ceftin^®) Pregnancy: B; Lactation: Unsafe Tabs: 125 mg, 250 mg, 500 mg Oral Susp: 125 mg/5 mL, 250 mg/5 mL	Children >3 months to 12 years: 30 mg/kg/day (max 1 g/day) in divided doses twice daily for 21 days. 125 mg/5 mL @ 30 mg/kg/day 8 kg (18 lb) = 1 tsp (5 mL) Q12H 12.5 kg (27 lb) = 1½ tsp (7.5 mL) Q12H 17 kg (37 lb) = 2 tsp (10 mL) Q12H 25 kg (55 lb) = 3tsp (15 mL) Q12H	Food: Take suspension with food. Tablets may be taken without regard to food. Reduce dose in renal disease (CrCl <30 mL/min).
	>33 kg (73 lb) = Use adult dose. Children ≥13 years or Adult: 500 mg PO twice daily for 21 days.
Erythromycin estolate or base (E-mycin^®, Ilosone^®) Generics available Pregnancy: B; Lactation: Unsafe Note: Higher rate of clinical failure compared to amoxicillin and doxycycline. Use only for patients with documented allergy to beta-lactams and tetracyclines. Estolate: Tabs: 500 mg Caps: 250 mg Oral Susp: 125 mg/5 mL, 250 mg/5 mL Base: Tabs: 250 mg, 333 mg, 500 mg Caps: 250 mg -	Children: 30-40 mg/kg/day estolate (max 2 g/day) in two to four divided doses daily for 21 days. 125 mg/5 mL @ 30 mg/kg/day 4 kg (10 lb) = ½ tsp (2.5 mL) Q12H 5-8 kg (11-18 lb) = 1 tsp (5 mL) Q12H 9-12 kg (20-26 lb) = 1 tsp (5 mL) Q8H 13-16 kg (29-35 lb) = 1 tsp (5 mL) Q6H 250 mg/5 mL @ 30 mg/kg/day 13-16 kg (29-35 lb) = 1 tsp (5 mL) Q12H 17-25 kg (37-55 lb) = 1 tsp (5 mL) Q8H 26-33 kg (57-72 lb) = 250 mg Q6H Adult: Erythromycin base or estolate 250 mg PO four times daily for 21 days.	Food: May take with or without meals. Take with food if causes GI upset. Important side effects: GI upset, hepatitis.
Penicillin V Potassium (Pen Vee K^®) Generics available Pregnancy: B; Lactation: Unsafe Tabs: 125 mg, 250 mg, 500 mg	Children: Inadequate information to recommend use in children at this time. Adult: 500 mg PO every 6 hours for 21 days.	Food: Take 1 hour before or 2 hours after meals. May take with food if GI upset occurs. Important side effects: Nausea, rash. Use cautiously if history of seizures.
SKIN - Lyme Disease, Acute Infection, Pregnant Woman (Borrelia burgdorferi)
Amoxicillin (Amoxil^®) Generics available Pregnancy: B; Lactation: Unsafe Caps: 250 mg, 500 mg -	Adult: 500 mg PO three times daily for 21 days.	Food: May take with or without meals. Important side effects: Diarrhea and nausea. May cause nonallergic maculopapular rash.
Tabs: 500 mg -		Reduce dose in renal disease (CrCl <30 mL/min).
SKIN - Lyme Disease - Arthritis or Isolated Facial Nerve Palsy (Borrelia burgdorferi)
Amoxicillin (Amoxil^®) Generics available Pregnancy: B; Lactation: Unsafe Caps: 250 mg, 500 mg   Tabs: 500 mg, 875 mg   Chewable Tab: 125 mg, 200 mg, 250 mg, 400 mg   Susp: 125 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL   Oral drops: 50 mg/mL	Children: Facial Paralysis: 40-50 mg/kg/day (max 1500 mg/day) in divided doses three times daily for 21-30 days. Arthritis: Four times daily for 28 days. 250 mg/tsp @ 40 mg/kg/day 10 kg (22 lb) = ½ tsp (2.5 mL) Q8H 15 kg (33 lb) = ¾ tsp Q8H 20 kg (44 lb) = 1 tsp (5 mL) Q8H >20 kg = Use adult dose. Adult: Facial paralysis: 500 mg PO three times daily for 21-30 days. Arthritis: Four times daily for 28 days	Food: May take with or without meals. Important side effects: Diarrhea and nausea. May cause nonallergic maculopapular rash.
Doxycycline (Vibramycin^®) Generics available Pregnancy: D; Lactation: Unsafe Note: A drug of choice, especially for persons intolerant to beta-lactams. Consider in younger children if true beta-lactam allergy. Caps: 50 mg, 100 mg   Tabs: 100 mg   Oral Susp: 25 mg/5 mL   Syrup: 50 mg/5 mL	Children: 2-4 mg/kg/day (max 200 mg/day) in two divided doses for 21-30 days (facial paralysis) or 28 days (arthritis). (Ped Infect Dis J 1990;18:913-925.) Children ≥8 years and Adult: 100 mg PO twice daily for 21-30 days (facial paralysis) or 28 days (arthritis).	Food: May take with food if GI upset occurs. Take 1 hour before or 2 hours after antacids, iron, milk, or other dairy)products. Take with full glass of water to prevent esophagitis. Important side effects: Photosensitivity, (use sunscreen), esophagitis. May discolor fingernails. Low chance of staining teeth in young children; avoid repeated courses.