Guidelines for Lyme borreliosis: treatment

The aim of the clinical practice guideline is to support healthcare professionals in the diagnosis and management of patients with proven or suspected Lyme borreliosis (LB). The guideline provides an evidence-based algorithm for antibiotic therapy in confirmed LB cases and outlines recommendations for complex presentations where the three diagnostic criteria are not fully met, suggesting a possible challenge antibiotic therapy in specialized settings. Updated in accordance with international literature and previous French recommendations (HAS, 2022), the guidelines detail antibiotic selection and treatment duration according to clinical manifestations. Doxycycline remains the first-line treatment in most situations, including for children under eight years and pregnant or breastfeeding women. Treatment duration varies from 10 to 28 days depending on disease presentation: 10 days for isolated erythema migrans, 14 days for multiple erythema migrans or early neuroborreliosis, 21 days for lymphocytoma or late neuroborreliosis, and 28 days for Lyme arthritis or acrodermatitis chronica atrophicans. Longer treatments are not justified. In complex or recurrent cases, referral to a reference center is recommended. The guideline discourages the use of anti-inflammatory drugs in acute LB management and notes that corticosteroids do not worsen Lyme-related peripheral facial palsy. European treatment recommendations remain largely consistent across countries.