A 10-year-old with a 12-day history of rash and intermittent fever has an annular indurated lesion on the thigh and two small papules with surrounding erythema. An appropriate treatment approach is:

A 10-year-old with a 12-day history of rash and intermittent fever has an annular indurated lesion on the thigh and two small papules with surrounding erythema. An appropriate treatment approach is:

• A. Admission to the hospital for parenteral ceftriaxone
• B. Administration of amoxicillin, doxycycline, or erythromycin at appropriate doses for 14 to 21 days; administration of antipyretics or analgesics; and observation
• C. Dermatology referral for skin biopsy
• D. Warm compresses, administration of antipyretics, and close observation

Answer: (B)

Early Lyme disease presenting with an expanding annular lesion (erythema migrans) is treated with outpatient oral antibiotics rather than hospital admission or invasive testing. In a child, appropriate choices include amoxicillin, doxycycline (usually if 8 years or older), or erythromycin, given at pediatric doses for about 14 to 21 days. Along with antibiotics, symptomatic care with antipyretics or analgesics and observe for response is standard. Hospital admission for intravenous ceftriaxone is reserved for more serious or disseminated involvement or when oral therapy isn’t suitable, not for typical early localized Lyme disease. Skin biopsy isn’t needed for a straightforward erythema migrans diagnosis and is unlikely to change management. Warm compresses alone do not address the underlying infection and aren’t sufficient without antibiotics.

Early Lyme disease presenting with an expanding annular lesion (erythema migrans) is treated with outpatient oral antibiotics rather than hospital admission or invasive testing. In a child, appropriate choices include amoxicillin, doxycycline (usually if 8 years or older), or erythromycin, given at pediatric doses for about 14 to 21 days. Along with antibiotics, symptomatic care with antipyretics or analgesics and observe for response is standard.

Hospital admission for intravenous ceftriaxone is reserved for more serious or disseminated involvement or when oral therapy isn’t suitable, not for typical early localized Lyme disease. Skin biopsy isn’t needed for a straightforward erythema migrans diagnosis and is unlikely to change management. Warm compresses alone do not address the underlying infection and aren’t sufficient without antibiotics.