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Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis
Guidelines by the Infectious Diseases Society of America
[Source / cid.oxfordjournals.org/] ou [Copie locale]

Early Lyme Disease :Erythema migrans.

The recommended for the treatment of adult patients with early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of specific neurologic manifestations (see Lyme meningitis, below) or advanced atrioventricular heart block (A-I).
---- Doxycycline (100 mg twice per day),(range, 14 days
---- Amoxicillin (500 mg 3 times per day), 14-21 days
---- cefuroxime axetil (500 mg twice per day) 14-21 days

Cas particuliers (cf infra)
---- Amoxicillin–clavulanic
---- Ceftriaxone

Each of these antimicrobial agents has been shown to be highly effective for the treatment of erythema migrans and associated symptoms in prospective studies.
Doxycycline has the advantage of being effective for treatment of HGA (but not for babesiosis), which may occur simultaneously with early Lyme disease. Doxycycline is relatively contraindicated during pregnancy or lactation and in children !8 years of age.

Antibiotics recommended for children are amoxicillin (50 mg/kg per day in 3 divided doses [maximum of 500 mg per dose]), cefuroxime axetil (30 mg/kg per day in 2 divided doses [maximum of 500 mg per dose]), or, if the patient is 8 years of age, doxycycline (4 mg/kg per day in 2 divided doses [maximum of 100 mg per dose]) (A-II).

Macrolide antibiotics are not recommended as first-line therapy for early Lyme disease, because those macrolides that have been compared with other antimicrobials in clinical trials have been found to be less effective (E-I). When used, they should be reserved for patients who are intolerant of, or should not take, amoxicillin, doxycycline, and cefuroxime axetil.

For adults with these limitations, recommended dosage regimens for macrolide antibiotics are as follows: azithromycin, 500 mg orally per day for 7–10 days; clarithromycin, 500 mg orally twice per day for 14–21 days (if the patient is not pregnant); or erythromycin, 500 mg orally 4 times per day for 14–21 days.
The recommended dosages of these agents for children are as follows: azithromycin, 10 mg/kg per day (maximum of 500 mg per day); clarithromycin, 7.5 mg/kg twice per day (maximum of 500 mg per dose); or erythromycin, 12.5 mg/kg 4 times per day (maximum of 500 mg per dose). Patients treated with macrolides should be closely observed to ensure resolution of the clinical manifestations.

When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis, a reasonable approach is to treat with either cefuroxime axetil or Treatment, and Prevention of Lyme Disease,(dosage of amoxicillin–clavulanic acid for adults, 500 mg 3 times per day; dosage for children, 50 mg/kg per day in 3 divided doses [maximum of 500 mg per dose]), because these antimicrobials are generally effective against both types of infection (A-III).

Ceftriaxone, while effective, is not superior to oral agents and is more likely than the recommended orally administered antimicrobials to cause serious adverse effects. Therefore, ceftriaxone is not recommended for treatment of patients with early Lyme disease in the absence of neurologic involvement or advanced atrioventricular heart block (E-I).

Lyme meningitis and other manifestations of early neurologic Lyme disease.
The use of ceftriaxone (2 g once per day intravenously for 14 days; range, 10–28 days) in early Lyme disease is recommended for adult patients with acute neurologic disease manifested by meningitis or radiculopathy (B-I). Parenteral therapy with cefotaxime (2 g intravenously every 8 h) or penicillin G (18–24 million U per day for patients with normal renal function, divided into doses given every 4 h), may be a satisfactory alternative (B-I).

For patients who are intolerant of b-lactam antibiotics, increasing evidence indicates that doxycycline (200–400 mg per day in 2 divided doses orally for 10–28) days may be adequate (B-I). Doxycycline is well absorbed orally; thus, intravenous administration should only rarely be needed.

For children, ceftriaxone (50–75 mg/kg per day) in a single daily intravenous dose (maximum, 2 g) (B-I) is recommended. An alternative is cefotaxime (150–200 mg/kg per day) divided into 3 or 4 intravenous doses per day (maximum, 6 g per day) (B-II) or penicillin G (200,000–400,000 units/kg per day; maximum, 18–24 million U per day) divided into doses given intravenously every 4 h for those with normal renal function (BI).
Children 8 years of age have also been successfully treated with oral doxycycline at a dosage of 4–8 mg/kg per day in 2 divided doses (maximum, 100–200 mg per dose) (B-II).
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