This protocol addresses Lyme disease in the specific and serious setting of parenchymal involvement of the brain or spinal cord — a central nervous system complication in which Lyme disease directly affects brain or spinal cord tissue. This presentation is distinct from peripheral or meningeal neurological involvement and requires a targeted treatment strategy.
Patients with Lyme disease who have evidence of parenchymal involvement of the brain or spinal cord. This CNS presentation is managed differently from less severe or non-neurological forms of Lyme disease, and the route of antibiotic delivery is a key determinant of the approach.
In this setting, intravenous antibiotic therapy is strongly recommended over oral antibiotics (strong recommendation, moderate-quality evidence). The specific IV agent and the structured course are defined in the full protocol.
In patients with Lyme disease-associated parenchymal involvement of the brain or spinal cord, we recommend using IV over oral antibiotics (strong recommendation, moderate-quality evidence).
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