Early Lyme disease presenting with facial nerve palsy should be treated with which regimen?

Early Lyme disease presenting with facial nerve palsy should be treated with which regimen?

• A. Doxycycline or amoxicillin for 14 days
• B. Azithromycin for 3 days
• C. Ceftriaxone IV for 3 days
• D. Valacyclovir for 7 days

Answer: (A)

Early Lyme disease with facial nerve palsy is best treated with an oral antibiotic effective against Borrelia burgdorferi. Doxycycline is typically used in adults, given as 100 mg twice daily for about 14 days. Amoxicillin is a common alternative for those who can’t take doxycycline (such as pregnancy or children). This approach is appropriate because there is no evidence of meningitis or other severe CNS involvement, so intravenous therapy isn’t needed. IV ceftriaxone is reserved for more serious neurologic Lyme disease (like meningitis or radiculopathy) or other complex presentations, not for uncomplicated facial palsy. Azithromycin isn’t recommended due to poorer efficacy and higher relapse rates, and valacyclovir isn’t active against Borrelia.

Early Lyme disease with facial nerve palsy is best treated with an oral antibiotic effective against Borrelia burgdorferi. Doxycycline is typically used in adults, given as 100 mg twice daily for about 14 days. Amoxicillin is a common alternative for those who can’t take doxycycline (such as pregnancy or children). This approach is appropriate because there is no evidence of meningitis or other severe CNS involvement, so intravenous therapy isn’t needed.

IV ceftriaxone is reserved for more serious neurologic Lyme disease (like meningitis or radiculopathy) or other complex presentations, not for uncomplicated facial palsy. Azithromycin isn’t recommended due to poorer efficacy and higher relapse rates, and valacyclovir isn’t active against Borrelia.