title: Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease.
abstract: OBJECTIVE
  To compare the efficacy of cefuroxime axetil and doxycycline in the treatment of patients with Lyme disease associated with erythema migrans.
  
  
  METHODS
  Randomized, multicenter, investigator-blinded clinical trial with clinical evaluations during treatment (8 to 12 days) and at 1 to 5 days and 1, 3, 6, 9, and 12 months post-treatment.
  
  
  METHODS
  Three university referral centers and one private practice.
  
  
  METHODS
  A total of 123 patients with physician-documented erythema migrans.
  
  
  METHODS
  Patients were treated orally for 20 days with either cefuroxime axetil, 500 mg twice daily (63 patients), or doxycycline, 100 mg three times daily (60 patients).
  
  
  METHODS
  Resolution of erythema migrans and of signs and symptoms related to early Lyme disease as well as prevention of late Lyme disease.
  
  
  RESULTS
  A satisfactory clinical outcome (success or improvement) was achieved in 51 of 55 (93%) evaluable patients treated with cefuroxime axetil and in 45 of 51 (88%) patients treated with doxycycline (difference, 5%, 95% Cl, -5% to 14%). The only complication at 1 month post-treatment was Lyme arthritis in one patient who received doxycycline. Of the patients with satisfactory outcomes at 1 month post-treatment who were evaluable at 1 year post-treatment, a satisfactory outcome was achieved in 43 of 48 (90%) and in 35 of 38 (92%) patients treated with cefuroxime axetil and doxycycline, respectively (difference, -2%; Cl, -12% to 7%). Lyme arthritis did not develop in any patient after 1 month post-treatment, whereas peripheral neuropathy was suspected in one patient treated with cefuroxime axetil. Thirty percent of patients treated with cefuroxime axetil and 32% of those treated with doxycycline had one or more drug-related adverse events. Doxycycline was associated with more photo-sensitivity reactions (15% compared with 0%; P = 0.001) and cefuroxime axetil with more diarrhea (21% compared with 7%; P = 0.035) and Jarisch-Herxheimer reactions (29% compared with 8%; P = 0.005).
  
  
  CONCLUSIONS
  Cefuroxime axetil is well tolerated and appears to be equally as effective as doxycycline in the treating of early Lyme disease and in preventing the subsequent development of late Lyme disease.
authors.affiliation: New York Medical College, New York.
authors.forename: R B
authors.initials: RB
authors.lastname: Nadelman
authors.forename: S W
authors.initials: SW
authors.lastname: Luger
authors.forename: E
authors.initials: E
authors.lastname: Frank
authors.forename: M
authors.initials: M
authors.lastname: Wisniewski
authors.forename: J J
authors.initials: JJ
authors.lastname: Collins
authors.forename: G P
authors.initials: GP
authors.lastname: Wormser
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002444:Cefuroxime / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D002648:Child; D004311:Double-Blind Method; D004318:Doxycycline / Q000009:adverse effects / Q000627:therapeutic use*; D015787:Erythema Chronicum Migrans / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011355:Prodrugs / Q000009:adverse effects / Q000627:therapeutic use*; D013223:Statistics as Topic
chemical_list: D011355:Prodrugs; D004318:Doxycycline; D002444:Cefuroxime; C040738:cefuroxime axetil