Lyme Disease: The Daily PANCE Blueprint

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Lyme Disease: The Daily PANCE Blueprint

A 34-year-old man who hikes in rural Connecticut presents with a 4-day history of an expanding, 8 cm erythematous annular rash with central clearing on his thigh, plus low-grade fever, myalgias, and fatigue. He has no headache, facial droop, palpitations, or joint swelling. Vital signs are normal. Which of the following is the most appropriate first-line treatment?

A. Intravenous ceftriaxone
B. Amoxicillin
C. Oral doxycycline
D. Azithromycin
E. Cefuroxime axetil

Answer and topic summary

The answer is C. Oral doxycycline

This is early localized Lyme disease (erythema migrans). Per the 2020 IDSA/AAN/ACR Lyme guideline, first-line is oral doxycycline (a 10-day course treats EM) — preferred because it also covers co-infecting Anaplasma. Amoxicillin and cefuroxime are alternatives; IV ceftriaxone is reserved for neurologic Lyme or high-grade AV block.

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Covered under ⇒ PANCE Blueprint Infectious Disease ⇒ Spirochetal Disease ⇒ Lyme disease

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