Persistent Lyme Arthritis

Consult Infectious Diseases and Rheumatology

For persistent arthritis after first course of therapy for patients who have responded incompletely or who respond and then relapse soon after stopping therapy.

Infection Prevention and Control

Routine Practices

Most Likely Pathogen

Borellia burgdorferi

Suggested Regimen

Greater than or equal to 8 years of age


Less than 8 years of age

There are limited safety data on the use of doxycycline for > 21 days in children < 8 years of age

Penicillin Allergy

Cefuroxime 30 mg/kg/24h PO divided q12h
Maximum: 1 gram /24h

Duration of therapy

28 days

For patients who experience worsening of their arthritis

Ceftriaxone 50-75 mg/kg/day IV once daily for 14 - 28 days
Maximum: 2 gram /24h