Azithromycin versus penicillin V for the treatment of early lyme borreliosis

Abstract

In a randomized multicenter therapeutic trial, 32 patients with erythema migrans received oral azithromycin 500 mg once daily and 33 patients received phenoxymethylpenicillin (penicillin V) 1 million U three times daily for 10 days. Follow-up was for a median of 17 (range 3-32) months. Four weeks after initiation of therapy, 20 (62%) patients given azithromycin and 17 (51%) patients given penicillin V were completely free of all signs and symptoms and did not develop new ones subsequently (no significant difference). Three months after initiation of therapy, the corresponding figures were 25 (78%) azithromycin and 28 (85%) penicillin V recipients (no significant difference). There were only minor sequelae such as arthralgia, headache, fatigue, stiff neck and dysesthesia. Azithromycin led to a significantly faster resolution of the erythema migrans than penicillin V (p < 0.001). Significantly more patients with more severe compared with mild initial disease had an elevated IgM antibody titer prior to therapy (p < 0.001). Usually mild to moderate side effects occurred in 12 patients given azithromycin and five patients given penicillin V (p < 0.05). Azithromycin appears to be as effective as penicillin V for the treatment of early Lyme borreliosis and it seems to clear the erythema migrans more promptly.

Comparative Study of Azithromycin versus Doxycycline for Treatment of Early Lyme Borreliosis

“…Our study confirmed resul ts of some European authors of azithromycin efficacy (3,(10)(11)(12)(13)(14) and was in discordance with data from american authors, showing worse results (4). In conclusion, our findings showed that azithromycin was as effective as doxycycline in the treatment oferythema migrans.…”

Comparison of a Two- or Three-Week Regimen and a Review of Treatment of Erythema Migrans with Phenoxymethylpenicillin

“…In Europe, it is given for 10–20 days, though the optimal duration of treatment has not yet been determined [7,8,9,10,11]. The efficacy of penicillin G was first studied by Steere et al[ 12] in 1980 in 113 patients with EM.…”

Serological and Clinical one year follow-up of Patients with Erythema migrans treated in a Romanian Infectious Disease Hospital

“…Seropositivity to Borrelia burgdorferi sl, either at presentation or follow-up, was found in independent studies not to be a risk factor for treatment failure. [23,[25][26][27][28][29] Persistence of IgM and IgG antibodies was described even 10-20 years after infection in asymptomatic patients. [30] It might be assumed that sustained positive titers indicate a long-term serologic memory that results from an antigen-independent polyclonal activation and differentiation of memory B cells.…”