Pediatric Lyme can be bactericidal against spiro- fermentans co-infections. As is seen without the need for metronida- chetes and cell wall deficient in adults, the presence of a co- zole or tinidazole. If a particular forms and suppress the autoim- infection requires treatment medicine is working and is well mune reaction triggered by an regimen modification. If one has tolerated, continue it until the active Lyme infection. [21] a Babesia infection, the use of above criteria are met. [22] Children with Lyme disease are atovaquone or atovaquone with Conclusion: more prone to develop autoim- proguanil (Malarone), and azithromycin or clarithromycin is 1. It does not take long, certainly munity if they are HLA DR4 and less than 24-48 hours, for a small or HLA DR2 genotype positive as currently the treatment of choice. Hydroxychloroquine or Ixodes scapularis tick or nymph to well as having a 31 IgG Western attach, feed and disseminate blot. I have observed that chil- artimesinin may also be used. For Ehrlichia infections, doxycycline organisms in a young child with dren who have an autoimmune soft, thin, very vascular skin. reaction respond favorably to or minocycline should be used antibiotics, indicating that they regardless of the age of the child. 2. Children with Ixodes scapularis have a persistent infection driving The duration of treatment is tick attachments in the head/neck the autoimmunity. The use of usually shorter, such as 5-7 days in area, under the arms or under the hyperbaric oxygen therapy along a child under seven as opposed to collar bones and in the belly with the use of an antibiotic can a longer term treatment (one button seem to result in Borrelia be a powerful treatment as well. month or longer in older chil- burgdorferi spirochetes disseminat- Treatment should extend over 40 dren). Bartonella infections are ing rapidly to the brain causing dives at 2.4 atmospheres. Intra- best treated with trimethoprim- early central nervous system muscular injections of penicillin sulfamethoxazole, ciprofloxacin (CNS) symptoms. This may can be used for treating neuro- with or without azithromycin or occur because spirochetes are logical Lyme disease, as can rifampin. Mycoplasma fermentans is carried by arteries going to the intravenous antibiotics: penicillin, difficult to eradicate. The most brain via the circle of Willis. ampicillin, ceftriaxone, effective medications include 3. In order to eradicate all Borrelia cefotaxime, imipenem-cilastatin, rifampin with azithromycin, burgdorferi spirochetes, antibiotics azithromycin, metronidazole, tetracycline analogues with should be continued for 2 months doxycycline and vancomycin. azithromycin, or trimethoprim- after all symptoms of Lyme Ciprofloxacin, levofloxacin, and sulfamethoxazole with rifampin. disease resolve, for 2 months moxifloxacin are also effective in For these children as well as with after they no longer have a the treatment of Lyme disease children who have Lyme disease Jarisch-Herxheimer reaction, for 2 and co-infections, but are gener- alone, duration of treatment is months after they no longer have ally contraindicated in children measured by clinical response. a Lyme flare-up induced by a under the age of eighteen (age The criteria used for the cessation non-Lyme infection such as twelve for ciprofloxacin). Some- of antibiotic therapy is if a child common cold, chicken pox, times one can use lower doses can: 1) be Lyme symptom-free influenza, tonsillitis or menstrua- using two antibiotics and achieve for two months; 2) not have a tion. If these criteria are met favorable results if the child Lyme induced flare-up as a result then the child’s Lyme disease cannot tolerate necessary dosages of another infection, fatigue, appears cured and all Borrelia with simply a single antibiotic. emotional trauma or injury; 3) can burgdorferi spirochetes can be Forty-percent of the children in show a Western blot that does not considered eradicated. If antibi- my practice have Bartonella henselae, reflect active infection and 4) is otic therapy is stopped prema- Babesia microti, Ehrlichia (Ana- PCR negative. Many children turely, before all Lyme symptoms plasma), and/or Mycoplasma have been treated very well have resolved, then these children

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