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Table 3 Therapy for persistent Lyme arthritis refractory to the first antibiotic treatment

From: Treatment of Lyme borreliosis

Persistent Lyme arthritis
Antibiotic-refractory persistent arthritis Significant inflammation (effusion, limited range of motion, oligoarthritis) Repeat
   • Intravenous cefotaxime 50 mg/kg/day in one dose (maximum dose 2,000 mg/day)
   • Intravenous cefotaxime 200 mg/kg/day in three divided doses (maximum dose 6,000 mg/day)
   • Intravenous penicillin G 0.5 million U/kg/day in four to six divided doses (maximum 20 million U/day)
   for 14 days up to 28 days
  Limited inflammation (for example, monoarthritis) • Doxycycline 4 mg/kg/day in two divided doses (maximum 200 mg/day; after 8 years of age)
   for 28 days
   Additional anti-inflammatory therapy: nonsteroidal anti-inflammatory drugs
No remission reached In synovial fluid or synovia: Prolong antibiotic oral treatment for another month
     B. burgdorferi DNA present Consider
   • Intra-articular steroid injection
   • Disease-modifying antirheumatic drug therapy
   • Arthroscopic synovectomy
     B. burgdorferi DNA not present Consider
   • Intra-articular steroid injection
   • Disease-modifying antirheumatic drug therapy
   • Arthroscopic synovectomy