In cases of CNS or cardiac involvement in Lyme disease, which treatment is recommended?

In cases of central nervous system (CNS) or cardiac involvement in Lyme disease, intravenous ceftriaxone is the recommended treatment. This is primarily because Lyme disease can cause severe manifestations such as Lyme meningitis or Lyme carditis, which may require more aggressive therapy compared to the typical oral antibiotics used for early localized or early disseminated disease.

Ceftriaxone is a broad-spectrum cephalosporin that is effective against Borrelia burgdorferi, the causative agent of Lyme disease. Its intravenous administration is particularly useful in treating patients who present with neurological manifestations, as it achieves higher concentrations in the CNS compared to oral medications. It is crucial to provide effective treatment to prevent potential long-term complications associated with CNS involvement, such as encephalopathy or persistent neurocognitive deficits.

In contrast, doxycycline and amoxicillin are typically adequate for treating early localized and early disseminated Lyme disease, but they are not the first-line treatment for severe cases involving the CNS or heart. Quinine, on the other hand, is used for the treatment of malaria and does not have efficacy against Lyme disease. Therefore, the most appropriate choice for treating CNS or cardiac involvement in Lyme disease is intravenous ceftriaxone.