A patient presents with a target-like rash after a hike; what is the recommended treatment?

• A. Doxycycline for 21 days
• B. Amoxicillin for 10 days
• C. Cefuroxime for 14 days
• D. Azithromycin for 5 days

Answer: (A)

Lyme disease presenting with a target-like rash (erythema migrans) after a tick exposure is treated with doxycycline because this antibiotic is highly effective against Borrelia burgdorferi and is convenient to take orally. The 21-day course shown here provides an adequate duration to eradicate the infection and help prevent progression to later stages. While doxycycline is the first-line option for most adults, amoxicillin or cefuroxime can be used as alternatives in specific situations (for example, in pregnant patients or young children). Doxycycline should be avoided in pregnancy and in children under 8 due to effects on teeth and bones, and it can cause photosensitivity in anyone. If symptoms fail to improve promptly, reassess for alternative diagnoses or disseminated disease.