Where such treatment is given the IV will usually be in place for two to three weeks to deliver the 2grams of ceftriaxone per day.
Patients with acute neurological complications of Lyme disease such as meningitis or radiculopathy will often be recommended intravenous ceftriaxone treatment. Alternatively this subset of patients may be prescribed intravenous penicillin G or cefotaxime (although the two should not be used together) as these can enter the central nervous system to treat the infection.
Alternative IV Antibiotics for Lyme Disease
Some patients are intolerant to both penicillin and cephalosporins (such as ceftriaxone and cefotaxime) in which case doxycycline may be given either orally or intravenously for two to three weeks at a dose of 200-400mg per day in two separate doses. Children with neurological complications of Lyme disease may be given intravenous ceftriaxone or cefotaxime with penicillin G offering an alternative intravenous Lyme disease antibiotic should it be required.
Patients with first- or second-degree atrioventricular heart block resulting from Lyme disease are usually treated in the same way as patients with erythema migrans without carditis. Those with third-degree atrioventricular heart block are advised however to be treated in hospital with parenteral ceftriaxone. They may also need a temporary pacemaker during their treatment and recovery.
Deciding if Antibiotics are Needed for Lyme Disease Symptoms
In cases where a patient has Lyme disease and is suffering from facial palsy as a result there is little evidence to suggest that the use of antibiotics leads to a faster recovery. However, patients are likely to be prescribed antibiotics in such cases in order to prevent other symptoms of Lyme disease from arising. The diagnostic procedure for such patients may differ between doctors with some ordering lumbar punctures to investigate the presence of the disease and others reserving this invasive procedure for those who exhibit neurological symptoms. Where cerebrospinal fluid tests, or other clinical or laboratory finding, reveals possible involvement of the CNS, the patient is to be treated in the same fashion as outlined above for neurological complications of Lyme disease.
Patients with no abnormalities in cerebrospinal fluid are recommended to be treated along the same lines as those patients with erythema migrans. Pregnant patients receive the same treatment as other patients with the exclusion of any tetracyclines (such as doxycycline).
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