Erythema migrans: Three Weeks treatment for prevention of late Lyme borreliosis

Abstract

An open, randomized, prospective study was carried out to compare the clinical efficacy and safety of phenoxymethylpenicillin with that of minocycline in the treatment of erythema migrans. Sixty patients (minocycline 30, penicillin 30) were enrolled in the study. The two groups of patients were statistically homogeneous regarding age and sex distribution. IgG and IgM antibodies against Borrelia burgdorferi were determined by ELISA before and after treatment and 1 year thereafter. Thirty-nine patients completed the study. All these patients (penicillin 21, minocycline 18) who received a 21-day course of treatment were free of clinical symptoms of late Lyme borreliosis after 1 year. Serum antibodies against B. burgdorferi could be detected before treatment in 6/21 patients treated with penicillin and 3/18 patients treated with minocycline. After 1 year 8/39 patients were seropositive without any evidence of ongoing disease. In the remaining 21 patients treatment could not be completed with the initial antibiotic due to side effects (penicillin 9/30, minocycline 12/30). One patient, who stopped penicillin treatment at day 14 and one patient who stopped minocycline at day 4, developed fatigue and memory impairment within the observation period. A 3-week course of treatment with penicillin or minocycline is equally effective in treating patients with erythema migrans and preventing late symptoms of Lyme borreliosis.

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

“…In all cited studies of PenV treatment shown in table 4, treatment duration was only 10–14 days with only one exception [20]. In the latter study, a 100% cure rate was seen after 3 months.…”

“…table 3 summarizes the published data for EM treatment with PenV [8,9,10,11,12,17,18,19,20,21,22,23,24,25,26]. PenV was recommended as equally effective as doxycyclin, amoxicillin, cefuroxime, ceftriaxon, minocyclin and azithromycin for EM in Europe [27,28,29].…”

Isolation and polymerase chain reaction typing of Borrelia afzelii from a skin lesion in a seronegative patient with generalized ulcerating bullous lichen sclerosus et atrophicus

“…Serological tests for Bb antibodies were performed every year from 1991 to 1994 by enzyme‐linked immunosorbent assay (ELISA), using the supernatant of a mixture of sonicated B. afzelii and B. garinii as antigen. Peroxidase‐conjugated goat antihuman IgG antibody (Nordic Immunological Laboratories, Stockholm, Sweden) was used as reactant 26 . The results were analysed with a 400 AT photometer (SLT Laboratory Instruments, Salzburg, Austria) at a wavelength of 492 nm.…”

Early Lyme Borreliosis

“…However, a recent study in the United States has demonstrated that 10-day courses (of doxycycline) are sufficient to treat early Lyme borreliosis (Kowalski et al, 2010). In Europe, conflicting results have been published for the superiority of a either a two-week or a three-week regimen (Breier et al, 1996;Aberer et al, 2006), and current guidelines do not specify the optimum duration of therapy for EM.…”