Management of a Patient with Carditis Associated with Lyme Disease

 

Parameters:

(1) AV heart block

(2) clinical status

Heart Block	Clinical Status	Management
first degree, PR interval 0.21 to 0.29 seconds	asymptomatic	oral regimen
first degree, PR interval 0.21 to 0.29 seconds	symptomatic or hospitalized	IV regimen
first degree, PR interval >= 0.30 seconds	NA	IV regimen
second degree	NA	IV regimen, with or without temporary pacemaker
third degree block	NA	IV regimen, with or without temporary pacemaker

 

Duration of therapy: 14 to 21 days (2-3 weeks)

 

Oral doxycycline:

(1) adult: 100 mg po bid

(2) older child or adolescent: 2 mg/kg (max 100 mg) po bid

 

Contraindications to doxycycline:

(1) age < 8 years of age

(2) pregnant or lactating female

 

Oral amoxicillin:

(1) adult 500 mg po tid

(2) pediatric:16.66 mg/kg (max 500 mg) po tid

 

Intravenous ceftriaxone:

(1) adult 2 grams IV qd

(2) pediatric 50-75 mg/kg (up to 2 grams) IV qd

 

Intravenous cefotaxime:

(1) adult 2 grams IV tid

(2) pediatric 50-67 mg/kg (up to 2 grams) IV tid

 

A patient started on intravenous therapy can be switched to oral therapy if the patient is stable and the heart block has resolved.