A 10-year-old girl presents complaining of headache and muscle aches. She is diagnosed with a viral illness and sent home. Two days later she presents with a right sided facial paralysis and worsening headache. A CT scan is normal but her cerebrospinal fluid has a high lymphocyte count and a provisional diagnosis of Lyme neuroborreliosis is made, which is later confirmed on serology. The patient is commenced on a 3-week course of intravenous ceftriaxone. You wonder if there is any evidence to support managing this patient with oral antibiotics.

Clinical question

In children with Lyme neuroborreliosis (Lyme disease affecting the nervous system) [patient] are oral antibiotics [intervention] a comparable alternative to intravenous antibiotics [comparison] in inducing remission of symptoms [outcome]?

Search strategy

Primary sources

PubMed: “Lyme disease AND intravenous” yielded 180 hits, four of which were relevant and in the English …