Lyme carditis with haemodynamic instability is a serious cardiac complication of Lyme disease that requires prompt inpatient antibiotic management. The protocol below addresses patients aged 9 years and over presenting in this setting.

Clinical scenario: Lyme disease with Lyme carditis in a patient who is haemodynamically unstable, aged 9 years and over. This presentation calls for intravenous antibiotic therapy with close cardiac monitoring, according to evidence-based guidelines for Lyme disease management.

Treatment Approach — Partial Overview

The initial treatment is intravenous ceftriaxone, with a structured oral antibiotic switch pathway available once the patient stabilises.

Weight-based dosing, duration, and the full oral switch algorithm are in the complete protocol.

References

DOI: 10.1093/cid/ciaa1215

Lyme disease with Lyme carditis and haemodynamically unstable
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 once per day for 21 days (when an oral switch is being considered, use doxycycline)
Intravenous ceftriaxone for children under 50 kg: 80 mg/kg (up to 2 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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Treatment of Lyme Disease with Lyme Carditis, Haemodynamically Unstable (Age 9 and Over)

Treatment Approach — Partial Overview

References