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Amoxicillin - amoxicillin, doxycycline, and cefuroxime have all been shown to have equivalent efficacy for treatment of lyme disease. however, because this patient is only 6 years old, he should not be given doxycycline as a first line treatment unless the other regimens are contraindicated. macrolides, like azithromycin should not be used first line because they are poorly effective at eradicating infection. they may be used in patients who are intolerant of penicillins and cephalosporins and who cannot take doxycycline. first generation cephalosporins like cephalexin are not effective.