chronic

Lyme Disease

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources4 sources

ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class AD24.05 - condition scope only, no dose · Lyme Disease - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK431066/ · No dose - referral pathway, no medicine given in primary care · Lyme Disease - StatPearls - NCBI Bookshelf (NBK431066)

Verified against2 documents

No dose - referral pathway, no medicine given in primary care
Lyme Disease - disease-level clinical article (lyme-disease-full.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

The bite-site rash may burn, itch, or cause no sensation at all [itching · rash]
The erythema migrans rash appears in about 70% of patients, typically 7 to 14 days after the tick bite [rash · redness]
Left untreated, the rash can expand to as much as 20 cm across over 2 to 3 weeks [rash]
Low-grade fever with muscle aches, neck stiffness, and headache marks early localized disease [fever · headache · muscle pain · neck stiffness]
Facial nerve (Bell) palsy occurs in roughly 5% of patients with early disseminated Lyme disease [paralysis]
Late Lyme arthritis brings joint pain, swelling, and stiffness, mainly affecting the knee [joint pain]
Late-stage encephalopathy causes poor concentration, memory loss, and personality change [memory loss · poor concentration]

Signs — what you find (4)

Conjunctivitis is the most common eye finding in early disseminated Lyme disease
A slow-growing, painless, red-bluish plaque or nodule on the earlobe or breast suggests borrelial lymphocytoma [plaques]
Bluish-red discoloration and swelling on the backs of the hands and feet, mainly in older women, suggests acrodermatitis chronica atrophicans
Lyme carditis can present with arrhythmia or transient heart block [arrhythmia · heart block]

Tests (6)

Serologic testing starts with a sensitive screening immunoassay before any confirmatory test
A positive or equivocal screening test is followed by a Western blot for confirmation
The IgM immunoblot counts as positive with at least 2 of 3 bands, but only in the first 30 days of illness; the IgG immunoblot needs 5 to 10 positive bands and can be read at any time
Serologic testing is over 80% sensitive once neurologic or cardiac features are present
Hospital admission for continuous ECG monitoring is advised when PR interval prolongation exceeds 300 milliseconds
Serum antibody testing is favored over PCR or culture of joint fluid when Lyme arthritis is suspected

If not this — what else fits (4)

Southern tick-associated rash illness produces a similar rash and is a key mimic of erythema migrans
Viral meningitis and multiple sclerosis are considered when neuroborreliosis is suspected
Gout, septic arthritis, and early rheumatoid arthritis are differentials for Lyme arthritis
Post-treatment Lyme disease syndrome overlaps with long COVID, depression, hypothyroidism, and fibromyalgia

SourceStatPearls "Lyme Disease" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Single-dose prophylaxis after a qualifying tick bite

MAIN TREATMENT

NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)

1st line

Adult dose and duration

Tick-borne infection carried by Ixodes ticks, which are not established in Egypt - this is not a locally-acquired disease. If a patient returns from a Lyme-endemic area (Europe/North America) with a tick bite and the characteristic expanding rash, empiric doxycycline is the standard treatment and a GP could reasonably start it while arranging specialist referral. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

Cautions

RED FLAG - Acute Lyme carditis presenting with complete atrioventricular heart block, syncope, or myocarditis: assess urgently and refer.
Not endemic in Egypt. Relevant to a returning traveller or an imported case; consider the travel history before anything else.
No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to.
RED FLAG - Cardiac (Lyme carditis) and neurologic manifestations require hospital admission or specialist management rather than routine outpatient referral.
RED FLAG - Erythema migrans (an expanding target-like rash) after a tick bite abroad means starting treatment without waiting for serology, and facial palsy, cardiac conduction abnormalities, or arthritis suggesting disseminated disease needs referral.

SINGLE-DOSE PROPHYLAXIS AFTER A QUALIFYING TICK BITE

DOXYCYCLINE

Single-dose prophylaxis after a qualifying tick bite

1st line

Strength100 mg

Formoral.solid

Adult dose and duration

200 mg by mouth once, as a single dose - single dose

Paediatric dose

4.4 mg/kg/dose [child max 200 mg]

(Children take 4.4 mg/kg as a single dose, never more than 200 mg. A single dose is used at any age.)

Dose by weight
3kg	13.2 mg/dose
4kg	17.6 mg/dose
5kg	22 mg/dose
6kg	26.4 mg/dose
7kg	30.8 mg/dose
8kg	35.2 mg/dose
9kg	39.6 mg/dose
10kg	44 mg/dose
11kg	48.4 mg/dose
12kg	52.8 mg/dose
13kg	57.2 mg/dose
14kg	61.6 mg/dose
15kg	66 mg/dose
16kg	70.4 mg/dose
17kg	74.8 mg/dose
18kg	79.2 mg/dose
19kg	83.6 mg/dose
20kg	88 mg/dose
21kg	92.4 mg/dose
22kg	96.8 mg/dose
23kg	101.2 mg/dose
24kg	105.6 mg/dose
25kg	110 mg/dose
26kg	114.4 mg/dose
27kg	118.8 mg/dose
28kg	123.2 mg/dose
29kg	127.6 mg/dose
30kg	132 mg/dose
31kg	136.4 mg/dose
32kg	140.8 mg/dose
33kg	145.2 mg/dose
34kg	149.6 mg/dose
35kg	154 mg/dose
36kg	158.4 mg/dose
37kg	162.8 mg/dose
38kg	167.2 mg/dose
39kg	171.6 mg/dose
40kg	176 mg/dose
41kg	180.4 mg/dose
42kg	184.8 mg/dose
43kg	189.2 mg/dose
44kg	193.6 mg/dose
45kg	198 mg/dose
46kg	200 mg/dose (capped)
47kg	200 mg/dose (capped)
48kg	200 mg/dose (capped)
49kg	200 mg/dose (capped)
50kg	200 mg/dose (capped)

Dose source

Lyme Disease - StatPearls - NCBI Bookshelf (NBK431066)

Why

Egypt is not a Lyme country, so the single dose is for the patient who comes back from travel with a tick bite and no symptoms yet. One dose given early prevents the illness, which is why it belongs in primary care rather than behind a referral.

Cautions

This is prophylaxis only for a bite that meets the article's conditions - the tick identified as the right species, or the bite in a highly endemic area, or the tick attached for a prolonged period. A bite that meets none of them does not need an antibiotic.
It is for the patient who has no symptoms. Anyone with the spreading rash, fever or joint pain needs a full treatment course, not one tablet.
Take it with a full glass of water, sitting or standing, and not immediately before lying down, or it can burn the gullet.
Warn about sunburn - doxycycline makes the skin far more sensitive to sun, which matters in Egypt.

Egyptian brands

Egyptian brand	Manufacturer	Indicative price
FARCODOXIN 100MG 10 CAPS.	PHARCO	11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.	ADWIA	12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.	GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE	12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.	EIPICO	23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.	EL NILE.	30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.	TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA	46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.	PFIZER	65.00 EGP (6.50/unit)

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.