American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the appropriate treatment for recurrent symptoms of Lyme disease-related arthritis?

1. Oral prednisone

2. Oral amoxicillin

3. Intravenous ceftriaxone

4. Intravenous vancomycin

The correct answer is: Intravenous ceftriaxone

The appropriate treatment for recurrent symptoms of Lyme disease-related arthritis is intravenous ceftriaxone. This choice is correct because treatment with ceftriaxone is effective in addressing persistent Lyme arthritis, particularly in cases where earlier oral antibiotic therapy has failed or when there is evidence of more severe disease manifestations. Ceftriaxone is a broad-spectrum cephalosporin antibiotic that has good central nervous system penetration and is often used in severe or complicated cases of Lyme disease, including those involving significant joint inflammation. Recurrent arthritis can occur due to residual inflammation and immune response even after the infection is adequately treated, necessitating a more robust and effective antibiotic regimen that ceftriaxone provides. In contrast, other treatments mentioned do not address the specific needs of recurrent Lyme arthritis effectively. Oral prednisone, while anti-inflammatory, does not treat the underlying infection and may even worsen infection by suppressing the immune response. Oral amoxicillin is typically used for early Lyme disease or mild manifestations; it may not be sufficient for recurrent arthritis, especially after previous treatments. Intravenous vancomycin is primarily used for infections caused by resistant bacteria, such as MRSA, and is not indicated for Lyme disease. Thus, intravenous ceftriaxone is the most appropriate choice