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American Academy of Neurology Issues Lyme Disease Guidelines


The American Academy of Neurology last week published new evidence-based guidelines on the treatment of nervous system Lyme disease and post-Lyme syndrome. The Infectious Diseases Society of America has endorsed these guidelines, which focus on different treatments for different types of neurologic symptoms. Key recommendations include:


• Parenteral ceftriaxone, cefotaxime, or penicillin G are "probably safe and effective" options to treat meningitis or CSF pleocytosis.


• In the absence of severe (brain or spinal cord) involvement, oral doxycycline is "probably safe and effective." When doxycycline is contraindicated, alternatives are amoxicillin and cefuroxime axetil, but data to support these treatments are lacking.


• The highest level of evidence supports a recommendation against prolonged antibiotic courses for post-Lyme syndrome; symptomatic management is recommended instead.


• Two weeks of antibiotic treatment are recommended to eradicate neuroborreliosis.


• The data on the use of corticosteroids in patients with neuroborreliosis are limited and show no clear benefit or harm.


The guidelines also specify recommended doses of each antibiotic for adults and for children.

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