| Symptoms
& History
Physical
Findings
Stop
& Think
Lab
and X-Ray
Differential
Diagnosis
The
Disease
Treatment
Conclusions
Quiz
& Evaluation |
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Here's
how we are going to handle Mr. Martin
-
He needs to be on an antibiotic
that will kill the bug. He's not allergic to tetracyclines, so let's go
with Doxycycline 100 mg, twice daily (b.i.d). He's more likely to
be compliant when he has to take only twice a day. We'll give him a supply
for 21 days.
-
Since we have PCR confirmation
of the bug, there's no reason to repeat his anti-Borrelia antibody
titer in a month. If we didn't have the PCR results, we would need to confirm
our diagnosis with a "convalescent" antibody titer. We'd expect to see
a rise from our baseline value.
-
It would be a good idea to get
a baseline EKG just in case he relapses and shows up in a month
with an AV block or myocarditis. Here's what it looks like.
-
Let's have him back in a
week to be sure the erythema migrans is regressing.
Follow
up visit
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