Doxycycline versus tetracycline therapy for Lyme disease associated with erythema migrans.
BACKGROUND
Doxycycline is widely used to treat Lyme disease associated with erythema migrans. Whether it is comparable to tetracycline is unknown.


OBJECTIVE
We conducted a two-part retrospective analysis of (1) the safety and efficacy of doxycycline compared with tetracycline and (2) the safety and efficacy of a 14-day versus a 20-day course of doxycycline.


METHODS
Twenty-seven patients given tetracycline (500 mg four times a day for 14 days [group 1]) were compared retrospectively with 21 patients who received doxycycline (100 mg two or three times a day for 14 days [group 2]). The results for group 2 were also compared with that of 38 patients who received doxycycline for 20 days (100 mg three times daily) in a prospective treatment trial (group 3).


RESULTS
There was no significant difference in the incidence of adverse drug effects or in efficacy at 1 month, but at 1 year there was a trend toward a better outcome in the group treated with tetracycline (p = 0.08). A 14-day course of doxycycline was comparable to a 20-day course in the incidence of adverse drug effects and in clinical outcome.


CONCLUSIONS
The principal advantage of doxycycline over tetracycline for the treatment of Lyme disease associated with erythema migrans is the convenience of less frequent dosing, not enhanced efficacy or safety. There appears to be no advantage in extending treatment with doxycycline from 14 to 20 days.
Nowakowski
J
J
Department of Medicine, New York Medical College, Valhalla 10595.
Nadelman
R B
RB
Forseter
G
G
McKenna
D
D
Wormser
G P
GP
D000284:Administration, Oral; D000328:Adult; D000367:Age Factors; D004318:Doxycycline / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D015787:Erythema Chronicum Migrans / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008193:Lyme Disease / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D010787:Photosensitivity Disorders / Q000139:chemically induced; D011446:Prospective Studies; D012189:Retrospective Studies; D012449:Safety; D013752:Tetracycline / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D013752:Tetracycline; D004318:Doxycycline