title: Concentrations of doxycycline and penicillin G in sera and cerebrospinal fluid of patients treated for neuroborreliosis.
abstract: Concentrations of doxycycline and penicillin G in serum and cerebrospinal fluid (CSF) were analyzed in 46 patients during treatment for neuroborreliosis. Twenty patients were treated intravenously with penicillin G at 3 g every 6 h (q6h), and 26 patients were treated orally with doxycycline at 200 mg q24h. All samples were collected on day 13 of treatment. The median concentrations of penicillin G in serum were 0.5, 37, and 5.6 micrograms/ml before and 1 and 3 h after drug administration, and that in CSF was 0.5 (range, 0.3 to 1.6) microgram/ml after 2 to 3 h. The median concentrations of doxycycline in serum were 2.1, 6.1, and 4.7 micrograms/ml before and 2 and 6 h after drug administration, and that in CSF was 0.6 (range, 0.4 to 2.5) microgram/ml after 4 h. All patients had concentrations of penicillin G or doxycycline in CSF above the lowest reported MICs of penicillin G (0.003 microgram/ml) and doxycycline (0.12 microgram/ml) for Borrelia burgdorferi. However, no patients had a drug concentration in CSF above the highest reported MIC of penicillin G (8 micrograms/ml), and only one had a drug concentration in CSF above the highest reported MIC of doxycycline (2 micrograms/ml), despite good clinical response to treatment. No treatment failure or relapse was observed during a 1-year follow-up, although one patient treated with penicillin G and one treated with doxycycline were retreated because of residual pain. The chosen dosages of penicillin G and doxycycline seem to give sufficient concentrations in serum and CSF for the treatment of neuroborreliosis.
authors.affiliation: Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Karlsson
authors.forename: S
authors.initials: S
authors.lastname: Hammers
authors.forename: I
authors.initials: I
authors.lastname: Nilsson-Ehle
authors.forename: A S
authors.initials: AS
authors.lastname: Malmborg
authors.forename: B
authors.initials: B
authors.lastname: Wretlind
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001812:Blood-Brain Barrier / Q000187:drug effects; D015748:Borrelia burgdorferi Group; D004318:Doxycycline / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008193:Lyme Disease / Q000097:blood / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D008875:Middle Aged; D010400:Penicillin G / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D004318:Doxycycline; D010400:Penicillin G