Intravenous antibiotics are recommended for treating neurologic disease. One exception is isolated Bell’s palsy, for which oral regimens are acceptable. Approximately 60 percent of patients with late neurologic disease have significant improvement when treated with antibiotics. An additional 20 percent of patients respond initially, then relapse. Improvement may not begin until several months after initiating therapy.

Symptoms persist in some patients despite appropriate treatment. The explanation of such cases is controversial. Potential causes of persistent symptoms include irreversible tissue damage, ongoing autoimmune response, persistent spirochetosis, and misdiagnosis.

Table 2 Treatment of Lyme Disease
*	Drug	Adult Dosage	Pediatric Dosage
Early Disease Erythema Migrans	1.*Doxycycline	100mg po bid x 14-21 days	Contraindicated
	2.Amoxicillin	500mg po tid x 14-21 days	10mg/kg po tid x 10-21 days
	3.Cefuroxime Axetil	500mg po tid x 14-21 days	*
Arthritis
Oral	1.*Doxycycline	100mg po bid x 28 days	Contraindicated
	2.Amoxicillin	500mg po tid x 28 days	15 mg/kg po tid x 28 days
Parenteral	1.Ceftriaxone	2 g IV qd x 14-28 days	50-75 mg/kg IV qd x 14-28 days
	2.Penicillin G	4 million U IV q4h x 14-28 days	50,000 U/kg IV q4h x 14-28 days
Neurological Disease
General Early or Late	1.Ceftriaxone	2 g IV qd x 14-28 days	75-100 mg/kg IV qd x 14-28 days
	2.Penicillin G	4 million U IV q4h x 14-28 days	50,000 U/kg IV q4h x 14-28 days
	3.Cefotaxime	2 g IV q8h x 14-28 days	30-60 mg/kg IV tid x 14-28 days
Isolated Facial Palsy	1.*Doxycycline	100mg po bid x 21-28 days	Contraindicated
	2.Amoxicillin	500mg po tid x 21-28 days	8-15 mg/kg po tid x 21-28 days
Cardiac
Mild	1.*Doxycycline	100mg po bid x 21 days	Contraindicated
	2.Amoxicillin	250-500mg po tid x 21-28 days	8-15 mg/kg po tid x 21 days
Serious	1.Ceftriaxone	2 g IV qd x 14-21 days	50-75 mg/kg IV qd x 14-21 days
	2.Penicillin G	4 million U IV q4h x 14-21 days	50,000 U/kg IV q4h x 21 days
* Note that Doxycycline should not be given to pregnant or lactating women, nor should it be given to children less than 8 years old.