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Why hasn't this tender nodule responded to an antibiotic?

Why hasn't this tender nodule responded to an antibiotic?

Case 2:
A 63-year-old woman presents with a tender nodule of 10 days’ duration on the dorsum of her right hand. She does not remember any specific injury, but she does do her own housework. Another physician prescribed doxycycline, 100 mg bid; however, the nodule has persisted. You order a bacterial culture.

Pending the culture results, what action would you take?

A. Continue the doxycycline.
B. Change to minocycline.
C. Change to ciprofloxacin.
D. Change to cephalexin.
E. Change to trimethoprim/sulfamethoxazole.
F. Start intravenous antibiotics.
G. Perform a skin biopsy.

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