Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Lyme disease - Management
What antibiotics should I prescribe for erythema migrans (not pregnant or breastfeeding)?

For people with Lyme disease who present with erythema migrans alone (that is, there is no evidence of neurological, cardiac, or joint involvement), and who are not pregnant or breastfeeding, the following antibiotic regimens can be started in primary care (see also Prescribing information for antibiotics):

  • Adults
    • Treat with either of the following:
      • Doxycycline 100 mg twice daily, by mouth, for 14 days.
      • Amoxicillin 500 mg three times daily, by mouth, for 14 days.
    • If both doxycycline and amoxicillin are contraindicated, treat with:
      • Cefuroxime axetil 500 mg twice daily, by mouth, for 14 days, provided there is no history of anaphylaxis with a penicillin.
    • If erythema migrans cannot be reliably distinguished from bacterial cellulitis, treat with one of the following regimens:
      • Co-amoxiclav 500/125 mg three times daily, by mouth, for 14 days.
      • Cefuroxime axetil 500 mg twice daily, by mouth, for 14 days.
      • Amoxicillin 500 mg three times daily, by mouth, for 14 days plus flucloxacillin 500 mg four times daily, by mouth, for 7–14 days.
  • Children
    • If 12 years of age or older, treat with either of the following:
      • Amoxicillin 50 mg/kg/day in three divided doses (maximum 500 mg per dose), by mouth, for 14 days.
      • Doxycyline 100 mg twice daily, by mouth, for 14 days.
    • If younger than 12 years of age, treat with:
      • Amoxicillin 50 mg/kg/day in three divided doses (maximum 500 mg per dose), by mouth, for 14 days.
    • If both doxycyline and amoxicillin are contraindicated, treat with:
      • Cefuroxime axetil 30 mg/kg/day in two divided doses (maximum 500 mg per dose), by mouth, for 14 days, provided there is no history of anaphylaxis with a penicillin.
    • If erythema migrans cannot be reliably distinguished from bacterial cellulitis, treat with either of the following:
      • Co-amoxiclav (amoxicillin equivalent 50 mg/kg/day in three divided doses, maximum 500 mg per dose), by mouth, for 14 days.
      • Cefuroxime axetil 30 mg/kg/day in two divided doses (maximum 500 mg per dose), by mouth, for 14 days.
      • Amoxicillin 50 mg/kg/day in three divided doses (maximum 500 mg per dose), by mouth, for 14 days plus flucloxacillin at double the standard dose four times a day for 14 days (see the Prescriptions section Unclear if erythema migrans or cellulitis: children for age-appropriate doses).
  • If in doubt, seek specialist advice.

© NHS Institute for Innovation and Improvement