Which antibiotic is recommended for Lyme disease in a pregnant patient?

• A. Azithromycin
• B. Amoxicillin
• C. Doxycycline
• D. Ceftriaxone

Answer: (D)

When treating Lyme disease in pregnancy, the goal is to use an antibiotic that effectively targets Borrelia burgdorferi while prioritizing fetal safety. Doxycycline is avoided in pregnancy because it can affect fetal teeth and bone development. For pregnant patients with Lyme disease, oral amoxicillin is a common first-line option, and cefuroxime axetil is another acceptable oral choice. Intravenous therapy with ceftriaxone is reserved for more serious or disseminated disease—such as neurologic involvement (meningitis, radiculopathy) or cardiac involvement—or when there is failure of oral therapy, because IV ceftriaxone provides reliable CNS penetration and is effective in severe cases.

So, if there is concern for disseminated or neurologic Lyme disease during pregnancy, IV ceftriaxone becomes the preferred approach. For uncomplicated, early Lyme disease in pregnancy, amoxicillin (or cefuroxime) would typically be used rather than IV therapy.