The evidence shows that antibiotics are effective in treating Lyme disease with nervous system involvement.

Lyme disease is caused by the tick-borne spirochete Borrelia burgdorferi. Its complications can include meningitis, cranial neuritis, or radiculo- neuritis. More severe neurologic sequelae of the disease are parenchymal inflammation of the spinal cord, brain, or both; peripheral sensory neuropathy; and encephalopathy. Much controversy exists over the best treatment for neurologic Lyme disease. This structured literature review was intended to provide evidence-based guidelines for treating neurologic Lyme disease and post-Lyme disease syndrome. Having reviewed 353 abstracts, the authors analyzed 37 corresponding articles that contributed "relevant, assessable data." They concluded that parenteral penicillin, ceftriaxone, and cefotaxime are "probably safe and effective treatments for peripheral nervous system Lyme disease and for central nervous system Lyme disease with or without parenchymal involvement." Also, "peripheral nervous system Lyme disease and central nervous system Lyme disease without parenchymal involvement" can probably be safely and effectively treated with oral doxycycline. In post-Lyme disease syndrome, prolonged use of antibiotics is not recommended because it does not improve outcomes and may cause adverse events.

The crux of the matter. Patients diagnosed with Lyme disease affecting the nervous system should undergo 14 days of treatment with antibiotics. In the absence of parenchymal involvement, oral doxycycline therapy serves as a reasonable alternative to parenteral antibiotic therapy.