Guidelines for Lyme borreliosis: treatment.
Level 5 - mechanism / opinion, no new human data
Clinical practice guideline and expert consensus update.
PubMed 41314469 · doi:10.1016/j.idnow.2025.105204
What was done
This clinical practice guideline updated recommendations for the diagnosis and antibiotic management of proven or suspected Lyme borreliosis (LB), integrating international literature and previous French health authority (HAS, 2022) recommendations. It outlines antibiotic selection, specific durations by clinical presentation, guidance on complex presentations, and the role of adjunctive anti-inflammatory therapies.
What was found
The abstract reports clinical recommendations without comparative statistical figures: - First-line agent: Doxycycline is the first-line antibiotic in most situations, including in children under eight years and pregnant or breastfeeding women. - Treatment duration: 10 days for isolated erythema migrans; 14 days for multiple erythema migrans or early neuroborreliosis; 21 days for borrelial lymphocytoma or late neuroborreliosis; 28 days for Lyme arthritis or acrodermatitis chronica atrophicans. - Treatments longer than 28 days are deemed not justified. - Adjunctive therapies: Anti-inflammatory drugs are discouraged in acute LB management; corticosteroids do not worsen Lyme-associated peripheral facial palsy. - Complex cases: Referral to specialized reference centers is recommended when standard diagnostic criteria are incomplete or disease is recurrent.
Why it matters
This guideline clarifies standard antibiotic durations across diverse Lyme borreliosis manifestations, establishes doxycycline use across broader patient demographics, and reinforces that prolonged antibiotic courses beyond 28 days are unwarranted.
Limits
The abstract provides guideline consensus recommendations rather than primary empirical data or systematic review metrics. Specific consensus grading methodology, risk of bias assessments, and quantitative outcome measures supporting each duration recommendation are not provided in the abstract.
Cited by
- supports Doxycycline is the standard antibiotic therapy used to treat Lyme disease.