Except for neurologic and cardiac disease, most treatment can be oral.

1. Doxycycline (100 mg bid) is the agent of choice for men and nonpregnant women and is also effective against anaplasmosis.
2. Amoxicillin (500 mg tid), cefuroxime (500 mg bid), erythromycin (250 mg qid), and newer macrolides are alternative agents, preferred in that order.
3. More than 90% of pts have good outcomes with a 14-day course of treatment for localized infection or a 21-day course for disseminated infection.
4. Neuroborreliosis: IV treatment with ceftriaxone (2 g/d for 14-28 days) should be given. Cefotaxime or penicillin is an alternative.
5. Pts with high-degree AV block should receive a 28-day course that commences with IV ceftriaxone (or alternative IV drugs) until the high-degree AV block has resolved; oral agents can then be used to complete treatment.
6. Lyme arthritis: 30-60 days of PO antibiotic. For pts who do not respond to oral agents, re-treatment with IV ceftriaxone for 28 days is appropriate. If joint inflammation persists after therapy but PCR testing for B. burgdorferi DNA in joint fluid gives negative results, anti-inflammatory agents or synovectomy may be successful.
7. Chronic Lyme disease: Persistent musculoskeletal and neurocognitive symptoms with fatigue occur in a small percentage of pts after antibiotic treatment. Further antibiotic courses are not helpful; treatment consists of symptom-based supportive care.