Cefotaxime vs penicillin G for acute neurologic manifestations in Lyme borreliosis. A prospective randomized study.
We randomly assigned 21 patients with painful Lyme neuroborreliosis radiculitis (Bannwarth's syndrome) and neuroborreliosis meningitis to a 10-day treatment with either penicillin G. 4 x 5 million U/d (n = 10) or cefotaxime sodium, 3 x 2 g/d (n = 11), intravenously. We were not able to demonstrate clinical differences between groups, either during the 10-day treatment period or at follow-up examination a mean of 7.7 months after antibiotic therapy. Cerebrospinal fluid cefotaxime concentrations reached the minimum inhibitory concentration at the 90% level for Borrelia burgdorferi in all patients, while none of the patients treated with penicillin G had cerebrospinal fluid concentrations above the minimum inhibitory concentration at the 90% value. We conclude that patients with acute neurologic manifestations of Lyme borreliosis may benefit from a 10-day treatment with cefotaxime or penicillin G. Cerebrospinal fluid antibiotic concentrations above the minimum inhibitory concentration at the 90% value, as observed in all patients treated with cefotaxime, offer the most hope for long-term prognosis.
Pfister
H W
HW
Neurologische Klinik der Universität, Klinikum Grosshadern, München, West Germany.
Preac-Mursic
V
V
Wilske
B
B
Einhäupl
K M
KM
D000208:Acute Disease; D000368:Aged; D002439:Cefotaxime / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000188:drug therapy*; D010400:Penicillin G / Q000627:therapeutic use*; D011446:Prospective Studies; D011843:Radiculopathy / Q000188:drug therapy
D002439:Cefotaxime; D010400:Penicillin G