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Rifampicin Timing in PVE — SCE Infectious Diseases MCQ

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HardBone & Joint InfectionRifampicin Timing in PVESCE Infectious Diseases

A patient has persistent fatigue, pain and cognitive symptoms after two fully completed, appropriately selected antibiotic courses for Lyme disease. There is no objective evidence of active infection or an alternative emergency. What should be recommended?

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Correct answer: D — Avoid a third course; reassess and obtain specialist or reference-laboratory advice

Explanation lettering: E = shown as B · B = shown as E

D is correct. NICE advises against routinely offering further antibiotics after two completed courses when symptoms persist. The clinician should review whether the original diagnosis and treatment were sound, assess reinfection, treatment failure, organ damage and alternative causes, and discuss the case with an appropriate specialist or reference laboratory. Persistent symptoms do not by themselves prove viable Borrelia, and prolonged, alternating or flare-driven antibiotics expose the patient to line, drug and microbiome harms without established benefit.

Reference: NICE NG95: Lyme disease recommendations: https://www.nice.org.uk/guidance/ng95/chapter/Recommendations