Early Lyme Disease — Medical Practice MCQ
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EasyInfectious DiseasesEarly Lyme Disease
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Correct answer: B — Doxycycline 100 mg BID for 10 days
This presentation is early Lyme disease: travel to a wooded/tick-exposure area with fever and a typical erythema migrans rash. Erythema migrans is sufficiently specific for Lyme disease to treat clinically without waiting for serology. The best initial option is oral doxycycline, so B is correct. In UK guidance, the first-line adult regimen is doxycycline 100 mg twice daily or 200 mg once daily; NICE recommends a 21-day course, but among the listed answers B is the only option with the correct first-line drug, route and dose. Co-amoxiclav is not recommended for Lyme disease, IV ceftriaxone is reserved for selected disseminated disease such as significant neurological or cardiac involvement, azithromycin is an alternative when first-line agents are unsuitable, and no antibiotics is inappropriate.
Reference: NICE Guideline NG95, Lyme disease: diagnosis and management, Recommendations, 2018: https://www.nice.org.uk/guidance/ng95/chapter/Recommendations