Treatment of Lyme Disease Affecting the Central Nervous System (Age 9 and Over)
When Lyme disease involves the central nervous system in patients aged 9 years and over, a specifically structured antibiotic approach is indicated — distinct from treatment used in uncomplicated presentations.
Clinical Scenario
Lyme disease affecting the central nervous system in patients aged 9 years and over. In adults and young people aged 12 and over, antibiotic selection is guided by the specific symptom profile at presentation.
Treatment Approach — Partial Overview
Treatment involves antibiotic therapy that may be delivered intravenously or orally, with the route determined by clinical assessment. An oral switch may be considered under specific circumstances during the course of treatment.
The complete regimen — including dosing, weight-based adjustments for children, sequencing, and the full range of options — is available in the structured protocol below.
References
DOI: 10.1093/cid/ciaa1215
- Lyme disease affecting the central nervous system
- For adults and young people (aged 12 and over) diagnosed with Lyme disease, offer antibiotic treatment according to their symptoms as described in table 1.
- Intravenous ceftriaxone: 2 g twice per day or 4 g once per day for 21 days (when an oral switch is being considered, use doxycycline)
- Oral doxycycline: 200 mg twice per day or 400 mg once per day for 21 days
- Intravenous ceftriaxone for children under 50 kg: 80 mg/kg (up to 4 g) once per day for 21 days
- Oral doxycycline for children under 45 kg: 5 mg/kg in 2 divided doses on day 1 followed by 2.5 mg/kg daily in 1 or 2 divided doses for a total of 21 days
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