This protocol addresses Lyme disease presenting with neurological involvement — specifically meningitis, cranial neuropathy, radiculoneuropathy, or other peripheral nervous system (PNS) manifestations — in the absence of parenchymal involvement of the brain or spinal cord.
Management is directed at the underlying infection through antimicrobial therapy. The full protocol details the recommended agent options for adults and children, preferred duration, and guidance on adapting the treatment course.
In patients with Lyme disease-associated meningitis, cranial neuropathy, radiculoneuropathy, or with other PNS manifestations, we recommend using IV ceftriaxone, cefotaxime, penicillin G, or oral doxycycline over other antimicrobials (strong recommendation, moderate-quality evidence).
Treatment route may be changed from IV to oral during treatment.
The preferred antibiotic duration is 14–21 days.
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