That dose is for someone with the ONLY symptom being an EM rash.
Here is the full quote of the recommendation, with what we are talking about
underlined:
"
Clinicians should prescribe amoxicillin, cefuroxime or
doxycycline as first-line agents for the treatment of EM. Azithromycin is also an acceptable agent, particularly in Europe, where trials demonstrated it either outperformed or was as effective as the other first-line agents [46–49].
Initial antibiotic therapy should employ 4–6 weeks of amoxicillin 1500–2000 mg daily in divided doses, cefuroxime 500 mg twice daily or
doxycycline 100 mg twice daily or a minimum of 21 days of azithromycin 250–500 mg daily. Pediatric dosing for the individual agents is as follows: amoxicillin 50 mg/kg/day in three divided doses, with a maximal daily dose of 1500 mg; cefuroxime 20–30 mg/kg/day in two divided doses, with a maximal daily dose of 1000 mg and azithromycin 10 mg/kg on day 1 then 5–10 mg/kg daily, with a maximal daily dose of 500 mg. For children 8 years and older, doxycycline is an additional option. Doxycycline is dosed at 4 mg/kg/day in two divided doses, with a maximal daily dose of 200 mg. Higher daily doses of the individual agents may be appropriate in adolescents.
Selection of the antibiotic agent and dose for an individual patient should take several factors into account. In the absence of contraindications, doxycycline is preferred when concomitant Anaplasma or Ehrlichia infections are possibilities. Other considerations include the duration and severity of symptoms, medication tolerability, patient age, pregnancy status, co-morbidities, recent or current corticosteroid use cost, the need for lifestyle adjustments to accommodate certain antibiotics and patient preferences. Variations in patient-specific details and the limitations of the evidence imply that clinicians may, in a variety of circumstances, need to select therapeutic regimens utilizing higher doses, longer durations or combinations of first-line agents (Recommendation, very low-quality evidence).
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I did take out the reference numbers, as the program on this forum always seems to think I'm trying to tell it different print sizes - otherwise it's not changed other than adding in the underlining.
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Read More:
informahealthcare.com/doi/full/10.1586/14787210.2014.940900 If you go on to read the recommendations for treating Lyme with more than just an EM rash, you will see that the recommendation is different.
I am not discounting those that simply cannot use a larger dose, yet seem to heal - I'm only saying that in order to keep from having to be overly concerned about
relapsing - which should be a huge deal to anyone with these infections - they should really insist on more than just 200 mgs of Doxy, as it's been proven to be only bacteriostatic at those doses for Lyme disease with more than an EM rash, not bactericidal. (
study.com/academy/lesson/types-of-antibiotics-bacteriocidal-vsbacteriostatic-narrow-spectrum-vs-broad-spectrum.html)
Does Doxy have it's place then? Yes.
"There are four types of antibiotics in general use for Bb treatment. The TETRACYCLINES, including doxycycline and minocycline, are bacteriostatic unless given in high doses. If high blood levels are not attained, treatment failures in early and late disease are common. However, these high doses can be difficult to tolerate. For example,
doxycycline can be very effective but only if adequate blood levels are achieved either by high oral doses (300 to 600 mg daily) or by parenteral administration. www.lymenet.org/BurrGuide200810.pdftop of page 14.
And just to be clear here - this is
not an argument, however I do feel that it is very important to be sure that we have the right information. If you have found more reliable sources for treatment recommendations, please do list them - with links please.