Irrespective of her delay, the history of the rash is an indication for treatment. If in the delay Spacey developed symptoms of early disseminated Lyme disease, a longer course of therapy would be indicated. Lyme arthritis or the development of recurrent joint inflammation might be better treated with parenteral medications. The later stages of Lyme (cardiac or neurological infection), which are not likely to develop this rapidly, should be treated with parenteral medications (Ceftriaxone 1 to 2 grams QD for 14 to 28 days or Penicillin 3.3 million units q 6 hrs for 14 to 28 days).