American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the treatment approach for Lyme disease presenting with other neurologic manifestations?

1. Oral amoxicillin

2. Oral doxycycline

3. Ceftriaxone or intravenous penicillin G

4. Intravenous tetracycline

The correct answer is: Ceftriaxone or intravenous penicillin G

The treatment of Lyme disease that presents with neurologic manifestations, such as Lyme meningitis or radiculoneuritis, generally requires more aggressive therapy compared to earlier stages of the disease that can often be treated with oral antibiotics. In cases where neurological symptoms are present, such as severe headache, stiff neck, or altered mental status, intravenous antibiotics are recommended to ensure adequate penetration of the medication into the central nervous system. Ceftriaxone and intravenous penicillin G are both effective choices for treating neurologic Lyme disease. These agents have better CNS penetration compared to oral options, making them essential for treating conditions like Lyme neuroborreliosis. This reflects a deeper understanding of Lyme disease pathology, recognizing that neurologic involvement demands heightened therapeutic vigilance to eradicate the infection effectively. In contrast, oral amoxicillin or oral doxycycline may be sufficient for early-stage Lyme disease without significant neurologic involvement or with mild symptoms. However, once neurologic manifestations develop, the severity of the infection warrants the use of intravenous antibiotics for optimal outcomes. Intravenous tetracycline, while an option, is less commonly used today due to advancements in antibiotic formulations and practices, making ceftriaxone or penicillin G the preferred choices in practice.