Treatment of Lyme Disease in Lyme Carditis Without Significant PR Prolongation

This protocol addresses Lyme disease presenting with cardiac involvement (Lyme carditis) in patients who do not have significant PR prolongation (PR > 300 ms), other arrhythmias, or clinical manifestations of myopericarditis — a subset that can typically be managed in the outpatient setting.

Clinical scenario

Lyme carditis is present, but the patient's conduction abnormality is mild — PR interval remains below 300 ms — and there are no significant arrhythmias or signs of myopericarditis. This profile supports outpatient evaluation and management rather than hospital admission.

Treatment approach

For this presentation, oral antibiotic therapy is the preferred route over intravenous antibiotics. Multiple oral antibiotic options are available, used for a defined course length.

Full antibiotic selection, dosing, and regimen details are in the structured protocol below.

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References

In outpatients with Lyme carditis, we suggest oral antibiotics over IV antibiotics (weak recommendation, very low-quality evidence).
Patients with Lyme carditis who do not require hospital admission can be treated orally.
Oral antibiotic choices for Lyme carditis are doxycycline, amoxicillin, cefuroxime axetil, and azithromycin.

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