Diagnosis
- Erythema Migrans (EM): Clinical diagnosis (typically ≥5cm). Treat immediately; do not wait for blood tests.
- Testing: If no EM but symptoms present (fever, joint pain, facial palsy): ELISA test first. If negative but symptoms persist, repeat ELISA in 4–6 weeks.
- Confirmation: If ELISA positive → Immunoblot (Western Blot) to confirm.
Management
- First-line: Doxycycline 100mg bd for 21 days. (Amoxicillin 1g tds for 21 days if pregnant).
- Safety: Warn about Jarisch-Herxheimer reaction (fever/chills) shortly after starting treatment.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.