Rx for lyme disease rash

Q: Which antibiotic may be used to treat skin rash of Lyme disease? - select one

A) Azithromycin 

B) First-generation ϲерhаlοѕpоriոs 

C) Quinolones

D) Vancomycin 

Answer: A

The objective of this question is to highlight the fact that a rash from Lyme disease, if not treated appropriately, can harm the patient. A clinician might fall into the trap of using 'any antibiotic effective against cellulitis.'

First-generation ϲерhаlοѕpоriոs (cephalexin), quinolones, and vancomycin are not effective against rash from Lyme disease and may make the disease progress to systemic manifestations, including nervous or cardiac systems.

The drug of choice is doxycycline, but azithromycin or clarithromycin can be used as an alternative agent. Amoxicillin is also effective.

#ID

References:

1. Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Arthritis Rheumatol 2021; 73:12.

2. Strle F, Maraspin V, Lotric-Furlan S, et al. Azithromycin and doxycycline for treatment of Borrelia culture-positive erythema migrans. Infection 1996; 24:64.

3. Nowakowski J, McKenna D, Nadelman RB, et al. Failure of treatment with cephalexin for Lyme disease. Arch Fam Med 2000; 9:563.

4. Agger WA, Callister SM, Jobe DA. In vitro susceptibilities of Borrelia burgdorferi to five oral cephalosporins and ceftriaxone. Antimicrob Agents Chemother 1992; 36:1788.