Patient handout

Lyme disease (early localized → late)

PRODUCTION

1. Your condition

This handout is for lyme disease (early localized → late). Your care team identified this based on: erythema migrans (>=5 cm bullseye lesion in endemic area) (idsa 2024).

Other reasons your team may use this plan: recent tick bite in ixodes-endemic region (idsa 2024); new facial palsy or aseptic meningitis with exposure (idsa 2024); late monoarticular knee arthritis with exposure (idsa 2024).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
doxycycline	100 mg PO BID	PO	BID × 10-14 d	IDSA 2020 — preferred; covers Anaplasma co-infection; 10 d non-inferior to 14 d
amoxicillin	500 mg PO TID	PO	TID × 14 d	IDSA 2020 alternative; preferred in pregnancy
cefuroxime_axetil	500 mg PO BID	PO	BID × 14 d	IDSA 2020 alternative

Plan: Lyme — stage-based antibiotic regimen (IDSA/AAN/ACR 2020)

3. When to call your provider

Contact your care team if any of the following happen:

New cardiac symptoms — palpitations, syncope, PR ≥ 0.3 s or symptomatic AV block → ED + admit + cardiology + IV ceftriaxone or PO doxy + temporary pacing if symptomatic (IDSA / AAN / ACR 2020)
Severe headache / meningismus / altered mental status → ED + LP + IV ceftriaxone for severe neuroborreliosis (IDSA / AAN / ACR 2020)
Refractory arthritis after 2× 28-d courses → ID + rheumatology (IDSA / AAN / ACR 2020 — DMARD / synovectomy candidacy)
Persistent / progressive PTLDS symptoms beyond 6 mo despite functional rehab → multidisciplinary symptom-management (chronic pain, behavioral health) — NOT chronic antibiotics (IDSA / AAN / ACR 2020 strong against)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Mobitz II, complete AV block, or PR >300 ms with symptoms in patient with Lyme exposure (IDSA 2024)
Meningoencephalitis with altered mental status, severe meningitis, or progressive radiculopathy (IDSA 2024)
Lyme carditis with high-grade AV block — PR > 0.3 s OR Mobitz II OR complete heart block OR symptomatic high-grade AV (syncope, severe palpitations) in patient with tick exposure (IDSA / AAN / ACR 2020 — life-threatening if symptomatic)(life-threatening)
Lyme meningitis with severe headache + meningismus OR encephalitis with altered mental status OR progressive radiculopathy / radiculoneuritis with severe pain OR multiple cranial neuropathies (IDSA / AAN / ACR 2020)
Lyme exposure + severe atypical features suggesting tick-borne coinfection — hemolysis or hemoglobinuria (babesiosis Babesia microti) OR profound cytopenias + transaminitis + severe headache (anaplasmosis Anaplasma phagocytophilum) OR meningoencephalitis-with-rapid-deterioration in Northeast US summer (Powassan virus) OR relapsing fever pattern (hard tick relapsing fever Borrelia miyamotoi) (IDSA / AAN / ACR 2020)

5. Follow-up

Counsel about post-treatment Lyme symptoms (subjective fatigue / arthralgia common — antibiotic re-treatment NOT recommended; supportive care + functional rehab); tick prevention education (IDSA 2024)

6. Sources

Guideline: IDSA / AAN / ACR 2020 Clinical Practice Guidelines for Lyme Disease (Lantos et al CID 2021) + CDC Modified 2-Tier Serology (MMWR 2019 Mead) + NICE NG95 (2018, updated 2024) + IDSA single-dose post-exposure doxycycline (Nadelman NEJM 2001) + Klempner PTLDS no-antibiotic NEJM 2001