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Azithromycin and doxycycline for treatment ofBorrelia culture-positive erythema migrans

Azithromycin und Doxycyclin in der Therapie der kulturell nachgewiesenen Borrelieninfektion mit Erythema migrans

  • Special Addendum — Part I
  • Therapy And Prophylaxis In Lyme Borreliosis
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Summary

Adult patients with typical solitary erythema migrans, participating in prospective therapeutic studies on early Lyme borreliosis at the Lyme borreliosis Outpatient's Clinic, University Department of Infectious Diseases in Ljubljana, in 1991 to 1993, and followed up for 1 year, were included in the study. Only patients who were treated with azithromycin or doxycycline and in whomBorrelia burgdorferi was isolated from the border of the skin lesion prior to institution of antibiotic treatment were selected for presentation in this report. Fifty-eight patients received azithromycin (500 mg twice daily for the first day, followed by 500 mg once daily for 4 days) and 42 patients received doxycycline (100 mg twice daily for 14 days). The median duration of skin lesions after the beginning of treatment was 6.5 (2–30) days in the azithromycin group and 8 (2–35) days in the doxycycline group (nonsignificant difference). During the follow-up of 12 months one patient in each group developed major later manifestations of Lyme borreliosis and in 19 patients minor manifestations appeared: in nine (15.5%) treated with azithromycin and in ten (23.8%) receiving doxycycline. In one patient in the azithromycin group and in one patient in the doxycycline groupB. burgdorferi was isolated from normal appearing skin at the site of previous erythema migrans 2 months after the institution of antibiotic therapy. Five (8.6%) patients receiving azithromycin and nine (21.4%) patients receiving doxycycline reported mild to moderate gastrointestinal discomfort. In addition, five patients treated with doxycycline developed photosensitivity.

Zusammenfassung

In der vorliegenden Studie wurden erwachsene Patienten mit typischem solitären Erythema migrans, die an prospektiven Studien zur Behandlung der frühen Lyme-Borreliose an der Lyme-Borreliose-Ambulanz der Universitätsklinik Ljubljana, Abteilung für Infektionskrankheiten teilnahmen und ein Jahr lang nachbeobachtet wurden, aufgenommen. Im folgenden wird nur über die Patienten berichtet, bei denenBorrelia burgdorferi aus dem Rand der Hautläsion isoliert worden war, bevor eine Behandlung mit Azithromycin oder Doxycyclin eingeleitet wurde. 58 Patienten erhielten Azithromycin (500 mg zweimal täglich am ersten Tag, anschließend 500 mg einmal täglich für 4 Tage). 42 Patienten wurden mit Doxycyclin in einer Dosis von zweimal täglich 100 mg 14 Tage lang behandelt. Nach Einleitung der Therapie blieben die Hautläsionen in der Azithromycin-Gruppe im Median 6.5 (2–30) Tage, in der Doxycyclin-Gruppe 8 (2–35) Tage bestehen (Unterschied nicht signifikant). Während der 12monatigen Verlaufsbeobachtung entwickelte aus jeder Gruppe ein Patient schwerwiegende Folgeerscheinungen der Lyme-Borreliose, in 19 Fällen kam es zu geringfügigeren Manifestationen. Neun Fälle (15,5%) traten nach Behandlung mit Azithromycin und zehn (23,8%) nach Behandlung mit Doxycyclin auf. Bei je einem Patienten der Azithromycin und Doxycyclin-Gruppe wurdeB. burgdorferi aus augenscheinlich normaler Haut an der Stelle der früheren Erythema migrans-Läsion 2 Monate nach Einleitung der Antibiotikatherapie isoliert. Fünf Patienten (8,6%) berichteten unter Azithromycin und neun Patienten (21,4%) unter Doxycyclin über leichte bis mäßiggradige gastrointestinale Beschwerden. Zusätzlich trat bei fünf mit Doxycyclin behandelten Patienten eine Photosensitivität auf.

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Authors and Affiliations

  1. Dept. of Infectious Diseases, University Medical Centre Ljubljana, Japlijeva 2

    F. Strle M. D., Ph. D., J. Cimperman M. D., Vera Maraspin M. D. & Stanka Lotric-Furlan M. D.

  2. Institute for Microbiology, University of Ljubljana, Zaloska 4, 61000, Ljubljana, Slovenia

    Eva Ruźić-Sabljić

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  1. F. Strle M. D., Ph. D.
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  2. J. Cimperman M. D.
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Strle, F., Cimperman, J., Maraspin, V. et al. Azithromycin and doxycycline for treatment ofBorrelia culture-positive erythema migrans. Infection 24, 64–68 (1996). https://doi.org/10.1007/BF01780661

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