a . For patients who are allergic to penicillin, cefuroxime and erythromycin are alternative drugs.

b . Tetracyclines are contraindicated in pregnancy.

c . Corticosteroids should not be given.

d . Treatment has no effect on the resolution of facial nerve palsy; its purpose is to prevent late disease.

e . Arthritis is not considered persistent or recurrent unless objective evidence of synovitis exists at least 2 months after Treatment is initiated. Some experts administer a second course of an oral agent before using an IV-administered antimicrobial agent.

f . Ceftriaxone should be administered IV for Treatment of meningitis or encephalitis.

1 . Wormser GP, Dattwyler RJ, Shapiro ED, et al. The clinical assessment, Treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis . 2006;43(9):1089-1134  [PMID:17029130]