Oral doxycycline versus intravenous ceftriaxone for treatment of multiple erythema migrans: an open-label alternate-treatment observational trial

Stupica, Daša; Velušček, Maša; Blagus, Rok; Bogovič, Petra; Rojko, Tereza; Cerar, Tjaša; Strle, Franc

doi:10.1093/jac/dkx534

Cited by 21 publications

(24 citation statements)

References 25 publications

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“…The 1220 patients included in this study were ≥18 years of age with EM defined according to European criteria [8], and were enrolled prospectively in five clinical trials between June 2006 and October 2015 at the Lyme borreliosis outpatient clinic, University Medical Center Ljubljana, Slovenia [2,4,9,10,11]. Patients were referred by their general practitioners, and only exceptionally by other specialists.…”

Section: Methodsmentioning

confidence: 99%

Clinical Course, Serologic Response, and Long-Term Outcome in Elderly Patients with Early Lyme Borreliosis

Boršič

Blagus²,

Cerar

et al. 2018

JCM

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Infected elderly people often present with signs and symptoms that differ from those in younger adults, but data on the association between patient age and presentation of early Lyme borreliosis (LB) are limited. In this study, the association between patient age (18–44 years, young vs. 45–64 years, middle-aged vs. ≥ 65 years, elderly) and disease course, microbiologic characteristics, and the long-term outcome of treatment was investigated prospectively in 1220 adult patients with early LB manifesting as erythema migrans (EM) at a single-center university hospital. Patients were assessed at enrolment and followed-up for 12 months. Age was associated with comorbidities, previous LB, presenting with multiple EM, and seropositivity to borreliae at enrolment. The time to resolution of EM after starting antibiotic treatment was longer in older patients. At 12 months, 59/989 (6.0%) patients showed incomplete response. The odds for incomplete response decreased with time from enrolment (odds ratio (OR) of 0.49, 0.50, and 0.48 for 2-month vs. 14-days, 6-month vs. 2-month, and 12-month vs. 6-month follow-up visits, respectively), but were higher with advancing age (OR 1.57 for middle-aged vs. young, and 1.95 for elderly vs. young), in women (OR 1.41, 95% confidence interval (CI) 1.01–1.96), in patients who reported LB-associated constitutional symptoms at enrolment (OR 7.69, 95% CI 5.39–10.97), and in those who presented with disseminated disease (OR 1.65, 95% CI 1.09–2.51). The long-term outcome of EM was excellent in patients of all age groups. However, older patients had slower resolution of EM and higher odds for an unfavorable outcome of treatment (OR 1.57, 95% CI 1.05–2.34 for middle-aged vs. young; and OR 1.95, 95% CI 1.14–3.32 for elderly vs. young), manifested predominantly as post-LB symptoms. The presence of LB-associated constitutional symptoms at enrolment was the strongest predictor of incomplete response.

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Section: Methodsmentioning

confidence: 99%

Clinical Course, Serologic Response, and Long-Term Outcome in Elderly Patients with Early Lyme Borreliosis

Boršič

Blagus²,

Cerar

et al. 2018

JCM

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“…Data on comparison of pretreatment characteristics, adverse effects of therapy, and treatment outcomes according to antibiotic regimen in patients with MEM are published elsewhere. 9 Because the doxycycline treatment was not inferior to the ceftriaxone treatment, 9 the 2 treatment groups of patients with MEM were combined for further comparison with patients with solitary EM. For each patient with MEM, 2 consecutive patients with solitary EM were evaluated for enrollment.…”

Section: Setting and Participantsmentioning

confidence: 99%

“…The guidelines recommend oral cefuroxime axetil or amoxicillin for 14 to 21 days or oral doxycycline for 10 to 21 days and intravenous ceftriaxone sodium for those with neurological involvement or advanced atrioventricular heart block 4 ; however, some data suggest that MEM might predispose patients to less favorable treatment outcome compared with solitary EM. [5][6][7] Treatment of MEM has been specifically addressed in 1 study performed in the United States 8 and in 1 European report 9 ; other treatment studies included predominantly or exclusively patients with solitary EM. [5][6][7][10][11][12][13][14][15] The aim of the present study was to further investigate the potential differences in clinical course and treatment outcome between patients with MEM and patients with solitary EM.…”

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confidence: 99%

Comparison of Clinical Course and Treatment Outcome for Patients With Early Disseminated or Early Localized Lyme Borreliosis

et al. 2018

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IMPORTANCE Multiple erythema migrans (MEM) has been suggested as a risk factor for unfavorable antibiotic treatment outcome compared with solitary erythema migrans (EM). However, no direct comparison of early Lyme borreliosis manifested as MEM with solitary EM has been undertaken. OBJECTIVE To investigate the potential differences in clinical course and treatment outcome between MEM and solitary EM.

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“…Persistent symptoms after treatment were no more frequent in patients treated for ≤10 days as compared with longer courses in a retrospective cohort study with a mean follow-up duration of 2.9 years 123. For multiple erythema migrans, oral doxycycline for 14 days has been shown to be as effective as intravenous ceftriaxone in an open label alternate treatment trial among 200 patients 106…”

Section: Treatmentmentioning

confidence: 96%

“…In Europe, B garinii is particularly neurotropic, and typically associated with painful radiculoneuritis and lymphocytic meningitis (originally described as Bannwarth syndrome) 36. B afzelii primarily causes skin infections, including ACA and borrelial lymphocytoma, both of which are virtually absent in North America 52101105106…”

Section: Clinical Manifestations and Diagnosismentioning

confidence: 99%

Lyme borreliosis: diagnosis and management

Kullberg

Vrijmoeth

Schoor

et al. 2020

BMJ

109

118

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Lyme borreliosis is the most common vectorborne disease in the northern hemisphere. It usually begins with erythema migrans; early disseminated infection particularly causes multiple erythema migrans or neurologic disease, and late manifestations predominantly include arthritis in North America, and acrodermatitis chronica atrophicans (ACA) in Europe. Diagnosis of Lyme borreliosis is based on characteristic clinical signs and symptoms, complemented by serological confirmation of infection once an antibody response has been mounted. Manifestations usually respond to appropriate antibiotic regimens, but the disease can be followed by sequelae, such as immune arthritis or residual damage to affected tissues. A subset of individuals reports persistent symptoms, including fatigue, pain, arthralgia, and neurocognitive symptoms, which in some people are severe enough to fulfil the criteria for post-treatment Lyme disease syndrome. The reported prevalence of such persistent symptoms following antimicrobial treatment varies considerably, and its pathophysiology is unclear. Persistent active infection in humans has not been identified as a cause of this syndrome, and randomized treatment trials have invariably failed to show any benefit of prolonged antibiotic treatment. For prevention of Lyme borreliosis, post-exposure prophylaxis may be indicated in specific cases, and novel vaccine strategies are under development.

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Oral doxycycline versus intravenous ceftriaxone for treatment of multiple erythema migrans: an open-label alternate-treatment observational trial

Cited by 21 publications

References 25 publications

Clinical Course, Serologic Response, and Long-Term Outcome in Elderly Patients with Early Lyme Borreliosis

Clinical Course, Serologic Response, and Long-Term Outcome in Elderly Patients with Early Lyme Borreliosis

Comparison of Clinical Course and Treatment Outcome for Patients With Early Disseminated or Early Localized Lyme Borreliosis

Lyme borreliosis: diagnosis and management

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