What is the recommended intravenous (IV) antibiotic for Lyme disease?

From the Guidelines

Intravenous antibiotics for Lyme disease, such as ceftriaxone, should be reserved for severe cases, including those with neurologic involvement or advanced atrioventricular heart block, and administered at 2 grams once daily for 14-28 days depending on disease severity and organ involvement, as recommended by the Infectious Diseases Society of America 1. When considering intravenous (IV) antibiotic treatment for Lyme disease, it is crucial to weigh the severity of the disease and the potential benefits against the risks of IV therapy.

• The preferred parenteral regimen is ceftriaxone, with a dosage of 2 grams intravenously once per day for adults and 50–75 mg/kg intravenously per day in a single dose (maximum, 2 g) for children, as outlined in the guidelines 1.
• Alternative parenteral regimens include cefotaxime and penicillin G, but these are typically considered when ceftriaxone is not suitable or available 1. Key considerations in the management of Lyme disease include the potential for coinfections, such as those with Babesia microti or Anaplasma phagocytophilum, which may require additional or alternative treatments 1.
• Monitoring for side effects and potential complications of IV antibiotic therapy, such as diarrhea, allergic reactions, and secondary infections, is essential 1. The decision to initiate IV antibiotic therapy should be based on a thorough clinical assessment, taking into account the severity of symptoms, the presence of neurologic or cardiac involvement, and the patient's overall health status, as guided by the clinical practice guidelines by the Infectious Diseases Society of America 1.

From the Research

IV Antibiotic Treatment for Lyme Disease

• IV antibiotic treatment is considered for late or severe Lyme disease, including neurological manifestations such as neuropathy or encephalopathy 2.
• Ceftriaxone is a commonly used IV antibiotic for the treatment of Lyme disease, particularly in cases of Lyme arthritis and neuroborreliosis 3, 4.
• The optimal duration of IV ceftriaxone treatment is unresolved, with studies comparing 14-day and 28-day courses of therapy 4.
• Other IV antibiotics, such as penicillin G, may also be effective in treating Lyme disease, particularly in cases of Lyme arthritis 5.

Specific IV Antibiotic Regimens

• Ceftriaxone: 14-day or 28-day course of therapy, with a dosage of 2g IV every 24 hours 4.
• Penicillin G: 10-day course of therapy, with a dosage of 20 million units IV daily 5.
• Cefotaxime: may be used as an alternative to ceftriaxone, with a dosage of 2g IV every 8 hours 6.

Efficacy and Safety of IV Antibiotic Treatment

• IV antibiotic treatment is generally effective in resolving symptoms of Lyme disease, with a high cure rate in patients with Lyme arthritis 5.
• The efficacy of IV antibiotic treatment in patients with neurological manifestations of Lyme disease is less well established, with some studies suggesting that treatment may not always be effective 6.
• IV antibiotic treatment is generally well tolerated, with a low risk of adverse events 6.