Posted 11/30/2015 7:45 PM (GMT -5)
I'm really glad that you got that much for your daughter, but unfortunately, that's still not enough. Here are ILADS guidelines to prevent her from developing a chronic Lyme infection and relapsing at a later date. At 21 days, it's really of no more value than 20 days:
Treatment regimens of 20 or fewer days of phenoxymethyl-penicillin, amoxicillin, cefuroxime or doxycycline and 10 or fewer days of azithromycin are not recommended for patients with EM rashes because failure rates in the clinical trials were unacceptably high. Failure to fully eradicate the infection may result in the development of a chronic form of Lyme disease, exposing patients to its attendant morbidity and costs, which can be quite significant.
This is what Dr. Burrascano says in his Advanced Topics of Lyme Disease" - ILADS detailed adopted guidelines for the details of treatments:
TICK BITES
-
Embedded Deer Tick With No Signs or Symptoms of Lyme (see appendix):
Decide to treat based on the type of tick, whether it came from an endemic area, how it was removed,
and length of attachment (anecdotally, as little as four hours of attachment can transmit pathogens). The risk of transmission is greater if the tick is engorged, or of it was removed improperly allowing the tick's contents to spill into the bite wound. High-risk bites are treated as follows (remember the possibility of co
-infection!):
1) Adults: Oral therapy for 28 days.
2) Pregnancy: Amoxicillin 1000 mg q6h for 6 weeks. Test for Babesia, Bartonella and Ehrlichia.
Alternative: Cefuroxime axetil 1000 mg q12h for 6 weeks.
3) Young Children: Oral therapy for 28 days.
EARLY LOCALIZED
-
Single erythema migrans with no constitutional symptoms:
1) Adults: oral therapy - must continue until symptom and sign free for at least one month,
with a 6 week minimum.
2) Pregnancy: 1st and 2nd trimesters: I.V. X 30 days then oral X 6 weeks
3rd trimester: Oral therapy X 6
+ weeks as above.
Any trimester - test for Babesia and Ehrlichia
3) Children: oral therapy for 6+ weeks.
DISSEMINATED DISEASE
-
Multiple lesions, constitutional symptoms, lymphadenopathy, or any other manifestations of dissemination.
EARLY DISSEMINATED:
Milder symptoms present for less than one year and not complicated by immune
deficiency or prior steroid treatment:
1) Adults: oral therapy until no active disease for 4 to 8 weeks (4-6 months typical)
2) Pregnancy: As in localized disease, but treat throughout pregnancy.
3) Children: Oral therapy with duration based upon clinical response.
PARENTERAL ALTERNATIVES for more ill patients and those unresponsive to or intolerant of oral
medications:
1)Adults and children: I.V. therapy until clearly improved, with a 6 week minimum.
Follow with oral therapy or IM benzathine penicillin until no active disease for 6-8 weeks. I.V. may
have to be resumed if oral or IM therapy fails.
2) Pregnancy: IV then oral therapy as above.
LATE DISSEMINATED: present greater than one year, more severely ill patients, and those with prior
significant steroid therapy or any other cause of impaired immunity:
1) Adults and pregnancy: extended I.V. therapy (14 or more weeks), then oral or IM, if effective, to same endpoint. Combination therapy with at least two dissimilar antibiotics almost always needed.
2)Children: IV therapy for 6 or more weeks, then oral or IM follow up as above. Combination therapy usually needed.
You could continue her treatment with a natural protocol if you can't get more abx or if you don't wish to fight with her doctor any more.