In Lyme disease with neurologic involvement, what type of antibiotic therapy is preferred?

• A. Intravenous antibiotics
• B. Oral antibiotics
• C. Topical antibiotics
• D. No antibiotics

Answer: (A)

Lyme disease that affects the nervous system requires an antibiotic that can reach the central nervous system in effective concentrations. Intravenous administration achieves reliable and rapid CSF penetration, which is crucial for clearing bacteria from the CNS and resolving neurologic symptoms. This is why IV options like ceftriaxone or penicillin G are standard choices for neuroborreliosis and are typically given for a couple of weeks or more. Oral antibiotics, while useful for other Lyme manifestations, may not guarantee adequate CNS levels in neurologic involvement, making them less reliable in this scenario. Topical antibiotics aren’t relevant for a systemic CNS infection, and not treating would allow ongoing disease.