Justice
Forum Fanatic
Topics: 100
Posts: 1,881
|
A 32-year-old woman from New Jersey is evaluated because of a 3-day history of a slowly expanding lesion on her left thigh that is not painful or itching. The patient removed a tick from the site of the lesion approximately 3 weeks ago. She has documented allergies to doxycycline, sulfa drugs, and codeine.
On physical examination, she has a 10-cm ovoid erythematous lesion with no central clearing on her thigh. Examination is otherwise unremarkable. An antibody assay for Borrelia burgdorferi is negative.
Which of the following is most appropriate for treating this patient at this time?
A. Defer treatment pending the results of a repeat B. burgdorferi assay in 6 weeks
B. Administer amoxicillin for 21 days
C. Administer doxycycline for 21 days
D. Administer azithromycin for 21 days
___________________
Don't live in a town where there are no doctors
|
| WaqasQureshi
Forum Junior
Topics: 3
Posts: 96
|
the diagnosis is made clinically. Even if the titer is not positive, you start with the treatment.
C ...start with doxycycline
|
| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,208
|
B because she's allergic.
___________________
When men make the rules, God decides the exceptions.
|
| crazyserb
Forum Newbie
Topics: 4
Posts: 41
|
B
|
| ganesha123
Forum Senior
Topics: 8
Posts: 225
|
b
___________________
It has never been so bad, that it couldn't be worse...”
|
| cool doctor
Forum Junior
Topics: 1
Posts: 219
|
B
|
| CocaCola
Forum Guru
Topics: 35
Posts: 908
|
b - amox
___________________
There is one thing we can do, and the happiest people are those who can do it to the limit of their ability. We can be completely present. We can be all here. We can give all our attention to the opportunity before us!!!
|
| liliaeliz
Forum Elite
Topics: 28
Posts: 274
|
|
| Markus2009
Forum Senior
Topics: 9
Posts: 189
|
B
|
| amybmc
Forum Newbie
Topics: 4
Posts: 27
|
B
|
| Justice
Forum Fanatic
Topics: 100
Posts: 1,881
|
The correct answer is B
The patient has a classic history of early Lyme disease. She had a tick bite while in an endemic area, followed by a lesion consistent with erythema migrans. At this stage of the illness, the diagnosis is based on clinical guidelines alone, as 70% to 80% of patients with early disease will have a negative B. burgdorferi titer. Consequently, treatment should not await serologic confirmation.
Amoxicillin is the most appropriate therapy for this patient. It is as effective as cefuroxime-axetil but is significantly less expensive. Doxycycline may be the treatment of choice in adults because it provides prophylaxis against other tick-borne infections (ehrlichiosis and Rocky Mountain spotted fever). However, the patient is allergic to this drug. Azithromycin is less effective than amoxicillin and should only be used in patients who are intolerant of amoxicillin, cefuroxime, and doxycycline.
Although it is possible that the patient is co-infected withEhrlichia or Babesia, it would be inappropriate to test for them at this time. In the absence of clinical symptoms, these titers are unlikely to be positive or, if positive, may indicate past infection.
___________________
Don't live in a town where there are no doctors
|
|
| |
| | | | | | | | | | | |
