Rule of 7s for Lyme Neuroborreliosis in Children
Clinical decision rule to distinguish Lyme neuroborreliosis from aseptic meningitis in children with meningitis in Lyme-endemic areas. Avoids unnecessary lumbar puncture in low-risk patients.
Score interpretation
< 3 criteria -- low probability of Lyme neuroborreliosis; consider other causes of aseptic meningitis
→ Consider viral aseptic meningitis (enterovirus, HSV-2, EBV, VZV) as more likely diagnosis; Lyme serology (ELISA + Western blot) if epidemiological risk; if Lyme serology positive with neurological features, still treat; symptomatic management; LP may be deferred if clinical picture consistent with viral meningitis and child looks well; follow up in 24-48 hours; hospital admission if systemically unwell, immunocompromised, or cannot maintain oral intake.
All 3 criteria present -- high probability of Lyme neuroborreliosis; treat empirically
→ Treat empirically for Lyme neuroborreliosis while awaiting confirmatory serology; paediatric dose: doxycycline 4 mg/kg/day in 2 divided doses (max 200 mg/day) for 14-28 days (preferred >= 8 years); ceftriaxone IV 50-100 mg/kg/day (max 2 g/day) if < 8 years or doxycycline not tolerated for 14-28 days; amoxicillin alternative if mild facial palsy only; Lyme serology ELISA + Western blot (2-tier testing); CSF Borrelia antibody index if LP performed; LP: lymphocytic pleocytosis, elevated protein, normal glucose; notify public health if confirmed; tick removal education; repeat serology at 4-6 weeks; facial palsy typically recovers completely with treatment.
Interpretation bands for the Rule of 7s Lyme. Apply clinical judgement and local guidance.
References
- Avery RA et al. The Rule of 7s: simple scoring criteria to guide lumbar puncture in children with Lyme meningitis. Ann Emerg Med. 2019;73(3):219-228.
- NICE. Lyme disease. NICE guideline NG95. 2018.
Related
Curated clinical cross-links plus same-class fallbacks.
- Tick-borne encephalitis vaccine · Inactivated TBE vaccine
- Methotrexate (Dermatology — Psoriasis) · Disease-Modifying Antirheumatic / Immunosuppressant
- Valaciclovir (ENT — Ramsay Hunt / Bell's Palsy) · Antiviral (Prodrug of Aciclovir)
- Acetazolamide (Ménière's Disease) · Carbonic Anhydrase Inhibitor (Diuretic)
- Zinc acetate · Zinc salt (Wilson's disease)
- Sulfasalazine · Aminosalicylate / Disease-Modifying Antirheumatic Drug (DMARD)
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.