American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for Lyme disease with encephalopathy or encephalomyelitis?

1. Ceftriaxone or intravenous penicillin G

2. Azithromycin

3. Doxycycline

4. Trimethoprim-sulfamethoxazole

The correct answer is: Ceftriaxone or intravenous penicillin G

The recommended treatment for Lyme disease with encephalopathy or encephalomyelitis is ceftriaxone or intravenous penicillin G. This recommendation is based on the severity of neurological involvement in Lyme disease. When Lyme disease progresses to neuroborreliosis, which includes manifestations such as encephalopathy or encephalomyelitis, intravenous antibiotics are typically indicated. Ceftriaxone is a broad-spectrum cephalosporin that is effective against the Borrelia burgdorferi bacteria responsible for Lyme disease and penetrates the central nervous system effectively, making it suitable for treating central nervous system complications. Similarly, intravenous penicillin G is another option that has been established as effective in treating serious infections caused by Borrelia. Both options ensure adequate drug concentrations in the cerebrospinal fluid, which is crucial for effectively managing neurological manifestations of Lyme disease. Other options, such as azithromycin, doxycycline, and trimethoprim-sulfamethoxazole, while effective against Lyme disease in early stages or less severe cases, do not provide the same level of efficacy or penetration necessary for treating neurological complications. Therefore, ceftriaxone or intravenous penicillin G is the appropriate choice for managing Lyme disease in patients with ence