American Board of Internal Medicine (ABIM) Certification Practice Exam

How should Lyme disease with multiple erythema migrans and systemic symptoms like fever be treated?

1. Oral rifampin

2. Oral doxycycline

3. Intravenous vancomycin

4. Oral clindamycin

The correct answer is: Oral doxycycline

The treatment of Lyme disease, particularly in cases characterized by multiple erythema migrans and systemic symptoms such as fever, is effectively managed with oral doxycycline. Doxycycline is a tetracycline antibiotic that is particularly indicated for Lyme disease because it targets the Borrelia burgdorferi bacterium, which is responsible for the infection. It’s recommended for adults and children over the age of 8 and is known for its efficacy in treating early localized and disseminated forms of Lyme disease. The ability of doxycycline to not only relieve symptoms but also potentially prevent the development of late complications like Lyme arthritis or neurologic involvement is an important aspect of its use in this context. In cases of early Lyme disease with systemic involvement or multiple skin lesions, a standard course of doxycycline enhances the likelihood of complete resolution of the disease. Other treatment options, such as oral rifampin, intravenous vancomycin, and oral clindamycin, are not first-line therapies for Lyme disease and are better suited for other bacterial infections. Therefore, the selection of oral doxycycline aligns with evidence-based guidelines for treating active Lyme disease manifestations effectively.