Question

A 47-year-old man presents to the emergency department with a 4-day history of high fever, severe headache, profound myalgias, and chills. He recently returned from a week-long hiking trip in the Ozark Mountains of Arkansas, where he reports sustaining multiple tick bites. His temperature is $39.4^\circ\text{C}$ ($102.9^\circ\text{F}$), blood pressure is $118/76\text{ mmHg}$, and pulse is $105/\text{min}$. Physical examination reveals a non-toxic appearing man with no focal neurological deficits, no lymphadenopathy, and no skin rash. Laboratory studies show:

Hemoglobin: $13.8\text{ g/dL}$
Leukocyte count: $2,400/\text{mm}^3$
Platelet count: $82,000/\text{mm}^3$
Aspartate aminotransferase (AST): $145\text{ U/L}$
Alanine aminotransferase (ALT): $152\text{ U/L}$

Which of the following is the most appropriate empiric pharmacotherapy for this patient?