Skip to main content
SpringerLink
Log in

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

Vergleich von Phenoxymethylpenicillin mit Minocyclin in der Behandling des Erythema chronicum migrans

  • Special Addendum — Part I
  • Therapy And Prophylaxis In Lyme Borreliosis
  • Published:
Infection Aims and scope Submit manuscript

Summary

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 againstBorrelia 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 againstB. 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.

Zusammenfassung

Zum Vergleich der klinischen Wirksamkeit und Sicherheit einer Behandlung des Erythema chronicum migrans mit Phenoxymethylpenicillin und Minocyclin wurde eine offene, randomisierte klinische Studie durchgeführt. 60 ambulante Patienten (25 Männer, 35 Frauen im Alter von 19–80 Jahren) mit Erythema migrans erhielten nach einem Randomisierungsschema entweder eine Behandlung mit Phenoxymethylpenicillin (4,5 Mio IE/Tag für 21 Tage; Gruppe A) oder mit Minocyclin (200 mg/Tag für 21 Tage; Gruppe B). Die beiden Patientengruppen waren hinsichtlich Alter und Geschlecht homogen. Alle Patienten wurden bis zu 12 Monate nach Therapiebeginn nachkontrolliert. In beiden Gruppen kam es innerhalb der Behandlungszeit zur Abheilung des Erythema migrans. Alle 39 über 21 Tage behandelten Patienten zeigten bis zu 12 Monate nach Therapiebeginn keine Zeichen von Spätmanifestationen der Lyme-Borreliose. Hingegen wurden bei zwei Patienten, die vorzeitig die Therapie abgebrochen hatten (ein mit Penicillin behandelter Patient nach 14 Tagen und ein mit Minocyclin behandelter Patient nach 4 Tagen Therapiedauer), während des Beobachtungszeitraumes Müdigkeit und Konzentrationsstörungen beobachtet. 21 Patienten mußten aufgrund eines Therapieabbruches von der Evaluierung ausgeschlossen werden. Vor Therapiebeginn wurde eine humorale Immunantwort gegenBorrelia burgdorferi bei 6/21 Patienten der Penicillin-Gruppe und bei 3/18 Patienten der Minocyclin-Gruppe nachgewiesen. Ein Jahr nach Studienbeginn waren 8/39 Patienten seropositiv. Die Ergebnisse zeigen, daß Phenoxymethylpenicillin und Minocyclin in der Behandlung des Erythema migrans als gleichwertig einzuschätzen sind, wobei die Therapiedauer über 21 Tage als wesentlich für den Langzeittherapieerfolg angesehen wird.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dattwyler, R. J., Volkman, D. J., Conaty, S. M., Platkin, S. P., Luft, B. J. Amoxicillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet 336 (1990) 1404–1406.

    PubMed  Google Scholar 

  2. Massarotti, E. M., Luger, S. W., Messner, R. P., Wong, J. B., Johnson, R. C., Steere, A. C. Treatment of early Lyme disease. Am. J. Med. 92 (1992) 396–403.

    PubMed  Google Scholar 

  3. Berger, B. W., Johnson, R. C., Kodner, C., Coleman L. Failure ofBorrelia burgdorferi to survive in the skin of patients with antibiotictreated Lyme disease. J. Am. Acad. Dermatol. 27 (1992) 34–37.

    PubMed  Google Scholar 

  4. Weber, K., Neubert, U., Thurmayr, R. Antibiotic therapy in early erythema migrans disease and related disorders. Zbl. Bakt. Hyg. A 263 (1986) 377–388.

    Google Scholar 

  5. Liegner, K. B. Minocycline in Lyme disease. J. Am. Acad. Dermatol. 28 (1993) 131.

    Google Scholar 

  6. Goldberg, N. S. Minocycline in Lyme disease. J. Am. Acad. Dermatol. 28 (1993) 131.

    Google Scholar 

  7. Maibach, H. Second-generation tetracyclines, a dermatologic overview: clinical uses and pharmacology. Cutis 48 (1991) 411–417.

    PubMed  Google Scholar 

  8. Johnson, S. E., Klein, G. C., Schmid, G. P., Feeley, J. C. Susceptibility of the Lyme disease spirochete to seven antimicrobial agents. Yale J. Biol. Med. 57 (1984) 549–553.

    PubMed  Google Scholar 

  9. Klade, H., Aberer, E. Late complaints after erythema migrans. J. Spir. Dis. Tick-borne Diseases 1(2) (1994) 52–56.

    Google Scholar 

  10. Kersten, A., Poitschek, C., Rauch, S., Aberer, E. Effects of penicillin, ceftriaxone, and doxycycline on morphology ofBorrelia burgdorferi. Antimicrob. Agents Chemother. 39 (1995) 1127–1133.

    PubMed  Google Scholar 

  11. Preac-Mursic, V., Weber, K., Prister, H. W., Wilske, B., Gross, B., Baumann, A., Prokop, J. Survival ofBorrelia burgdorferi in antibiotically treated patients with Lyme borreliosis. Infection 17 (1989) 355–359.

    PubMed  Google Scholar 

  12. Liegner, K. B., Shapiro, J. R., Ramsay, D., Halperin, A. J., Hogrefe, W., Kong, L. Recurrent erythema migrans despite extended antibiotic treatment with minocycline in a patient with persistingBorrelia burgdorferi infection. J. Am. Acad. Dermatol. 28 (1993) 312–314.

    PubMed  Google Scholar 

  13. Hartwig, H., Mester, U., Krasemann, C. Minocyclin-Konzentration im menschlichen Kammerwasser nach oraler Applikation. Klin. Monatsbl. Augenheilkd. 173 (1978) 842–845.

    PubMed  Google Scholar 

  14. Flach, A. J., Lavoie, P. E. Episcleritis, conjunctivitis, and keratitis as ocular manifestations of Lyme disease. Ophthalmology 97 (1990) 873–875.

    Google Scholar 

  15. Berger, B. W., Kaplan, M. H., Rothenberg, I. R., Barbour, A. G. Isolation and characterisation of the Lyme disease spirochete from skin of patients with erythema chronicum migrans. J. Am. Acad. Dermatol. 13 (1985) 444–449.

    PubMed  Google Scholar 

  16. Grünberger, G. Alphabetischer Durchstreichtest und Grünberger Verbaler Gedächtnistest. In: Psychodiagnostik des Alkoholkranken. Maudrich, Vienna 1977, pp. 137–162.

    Google Scholar 

  17. Kaplan, R. F., Meadows, M. E., Vincent, L. C., Logigian, E. L., Steere, A. C. Memory impairment and depression in patients with Lyme encephalopathy: comparison with fibromyalgia and nonpsychotically depressed patients. Neurology 42 (1992) 1263–1267.

    PubMed  Google Scholar 

  18. Muellegger, R., Zoechling, N., Soyer, H. P., Hoedl, S., Wienecke, R., Volkenandt, M., Kerl, H. No detection ofBorrelia burgdorferi-specific DNA in erythema migrans lesions after minocycline treatment. Arch. Dermatol. 131 (1995) 678–682.

    PubMed  Google Scholar 

  19. Strle, F., Ruzic, E., Cimperman, J. Erythema migrans: comparison of treatment with azithromycin, doxycycline and phenoxymethylpenicillin. J. Antimicrob. Chemother. 30 (1992) 543–550.

    PubMed  Google Scholar 

  20. Steere, A. C., Hutchinson, G. J., Rahn, D. W., Sigal, L. H. Crahn, J. E., De Sanna, E. T., Malawista, S. C. Treatment of early manifestations of Lyme disease. Ann. Intern. Med. 99 (1983) 22–26.

    PubMed  Google Scholar 

  21. Weber, K., Pfister, H. W. Clinical management of Lyme borreliosis. Lancet 340 (1994) 1017–1020.

    Google Scholar 

  22. Dattwyler, R. J., Halperin, J. J. Failure of tetracycline therapy in early Lyme disease. Arthritis Rheum. 30 (1987) 448–450.

    PubMed  Google Scholar 

  23. Nadelman, R. B., Luger, S. W., Frank, E., Wisniewski, M., Collins, J. J., Wormser, G. P. Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme borreliosis. Ann. Intern. Med. 117 (1992) 273–280.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universitätsklinik für Dermatologie, Währinger Gürtel 18–20, A-1090, Wien

    F. Breier,  G. Kunz,  H. Klade &  Elisabeth Aberer

  2. Hygiene-Institut der Universität Wien, Kinderspitalgasse 15, A-1090, Wien, Austria

    G. Stanek

Authors
  1. F. Breier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Kunz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Klade
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Elisabeth Aberer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Stanek
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Breier, F., Kunz, G., Klade, H. et al. Erythema migrans: Three Weeks treatment for prevention of late Lyme borreliosis. Infection 24, 69–72 (1996). https://doi.org/10.1007/BF01780662

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01780662

Keywords

Search

Navigation