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Azithromycin versus penicillin V for the treatment of early lyme borreliosis

Azithromycin im Vergleich zu Penicillin V in der Therapie der frühen Lyme-Borreliose

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Summary

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.

Zusammenfassung

Bei einer randomisierten Multicenter-Therapiestudie erhielten 32 Patienten mit Erythema migrans (EM) 10 Tage lang täglich 500 mg Azithromycin und 33 Patienten 3x täglich 1 Mill. IE Penicillin V. Die Nachbeobachtungszeit betrug 17 (3–32) Monate. Die klinischen Erscheinungen heilten bei 20 (62%) der mit Azithromycin und 17 (51%) der mit Penicillin V behandelten Patienten innerhalb von vier Wochen und bei 25 (78%) der mit Azithromycin beziehungsweise 28 (85%) der mit Penicillin V behandelten Patienten innerhalb von drei Monaten nach Therapiebeginn vollständig ab, ohne erneut zu einem späteren Zeitpunkt aufzutreten (kein signifikanter Unterschied). Die klinischen Folgeerscheinungen waren nur leichter Art. Es handelte sich z. B. um Arthralgien, Kopfschmerzen, Abgeschlagenheit, Nackensteife und Paraesthesien. Durch Azithromycin kam es zu einer signifikant schnelleren Abheilung des EM als durch Penicillin V (p<0.001). Signifikant mehr Patienten mit ausgeprägteren als mit milden Initialerscheinungen hatten einen erhöhten IgM-Antikörper-Titer vor Therapiebeginn (p<0.001). Meistens gering- bis mäßiggradige Nebenwirkungen fanden sich bei 12 mit Azithromycin und fünf mit Penicillin V behandelten Patienten (p<0.05). Azithromycin ist offensichtlich ähnlich wirksam wie Penicillin V bei der Behandlung der frühen Lyme-Borreliose, aber Azithromycin scheint das EM schneller abzuheilen.

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Authors and Affiliations

  1. Dematologische Praxis, Rosenstraße 6, D-80331, München

    K. Weber

  2. Abteilung für Mikrobiologie, Max von Pettenkofer Institut, Universität München, Pettenkoferstraße 9 a, D-80336, München

    Bettina Wilske &  Vera Preac-Mursic

  3. Abteilung für Medizinische Epidemiologie und Statistik, Technische Universität München, Ismaningerstraße 22, D-81675, München, Germany

    R. Thurmayr

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  1. K. Weber
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  2. Bettina Wilske
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  3. Vera Preac-Mursic
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  4. R. Thurmayr
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Weber, K., Wilske, B., Preac-Mursic, V. et al. Azithromycin versus penicillin V for the treatment of early lyme borreliosis. Infection 21, 367–372 (1993). https://doi.org/10.1007/BF01728915

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