Antibiotics are the primary treatment. The specific approach to their use is dependent on the individual affected and the stage of the<unk> . For most people with early localized infection, oral administration of doxycycline is widely recommended as the first choice, as it is effective against not only Borrelia bacteria but also a variety of other illnesses carried by ticks. People taking doxycycline should avoid sun exposure because of higher risk of sunburns. Doxycycline is contraindicated in children younger than eight years of age and women who are pregnant or breastfeeding; alternatives to doxycycline are amoxicillin, cefuroxime axetil, and azithromycin. Azithromycin is recommended only in case of intolerance to the other antibiotics. The standard treatment for cellulitis, cephalexin, is not useful for<unk> . When it is unclear if a rash is caused by<unk>  or cellulitis, the IDSA recommends treatment with cefuroxime or amoxicillin/clavulanic acid, as these are effective against both infections. Individuals with early disseminated or late<unk>  infection may have symptomatic cardiac<unk> ,<unk>  arthritis, or neurologic symptoms like facial palsy, radiculopathy, meningitis, or peripheral neuropathy. Intravenous administration of ceftriaxone is recommended as the first choice in these cases; cefotaxime and doxycycline are available as alternatives. Treatment regimens for<unk>  range from 14 days in early localized<unk> , to 14–21 days in early disseminated<unk>  to 14–28 days in late disseminated<unk> . Neurologic complications of<unk>  may be treated with doxycycline as it can be taken by mouth and has a lower cost, although in North America evidence of efficacy is only indirect. In case of failure, guidelines recommend retreatment with injectable ceftriaxone. Several months after treatment for<unk>  arthritis, if joint swelling persists or returns, a second round of antibiotics may be considered; intravenous antibiotics are preferred for retreatment in case of poor response to oral antibiotics. Outside of that, a prolonged antibiotic regimen lasting more than 28 days is not recommended as no evidence shows it to be effective. IgM and IgG antibody levels may be elevated for years even after successful treatment with antibiotics. As antibody levels are not indicative of treatment success, testing for them is not recommended. Facial palsy may resolve without treatment; however, antibiotic treatment is recommended to stop other<unk>  complications. Corticosteroids are not recommended when facial palsy is caused by<unk> . In those with facial palsy, frequent use of artificial tears while awake is recommended, along with ointment and a patch or taping the eye closed when sleeping. About a third of people with<unk>  carditis need a temporary pacemaker until their heart conduction abnormality resolves, and 21% need to be hospitalized.<unk>  carditis should not be treated with corticosteroids. People with<unk>  arthritis should limit their level of physical activity to avoid damaging affected joints, and in case of limping should use crutches. Pain associated with<unk>  may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs). Corticosteroid joint injections are not recommended for<unk>  arthritis that is being treated with antibiotics. People with<unk>  arthritis treated with intravenous antibiotics or two months of oral antibiotics who continue to have joint swelling two months after treatment and have negative PCR test for Borrelia DNA in the synovial fluid are said to have antibiotic-refractory<unk>  arthritis; this is more common after infection by certain Borrelia strains in people with certain genetic and immunologic characteristics. Antibiotic-refractory<unk>  arthritis may be symptomatically treated with NSAIDs,<unk> -modifying antirheumatic drugs (DMARDs), or arthroscopic synovectomy. Physical therapy is recommended for adults after resolution of<unk>  arthritis. People receiving treatment should be advised that reinfection is possible and how to prevent it.
Lyme disease
Cellulitis
Mumps
Bell's palsy
Rabies
Meningitis
Rickettsialpox
Scarlet fever