Doxycycline versus ceftriaxone for the treatment of patients with chronic Lyme borreliosis.
BACKGROUND
Therapeutic guidelines for treatment of late manifestations of Lyme borreliosis have not yet become well established. Patients with symptoms suggesting central nervous system involvement are often treated with courses of intravenous ceftriaxone. This is an expensive treatment approach with potentially severe side effects. We compared the efficacy, side effects and costs of doxycycline and ceftriaxone in the treatment of such patients.


METHODS
Adult patients qualified for the study if they had nonspecific symptoms suggesting central nervous system involvement for more than six months (but without overt clinical signs of the involvement), had positive serum borrelial antibody titers and/or erythema migrans prior to the onset of symptoms, had not been previously treated with antibiotics and did not have pleocytosis in the cerebrospinal fluid. Patients were given either 100 mg of oral doxycycline twice daily for 4 weeks (23 patients) or 2 g of intravenous ceftriaxone daily for 2 weeks followed by 100 mg of doxycycline twice daily for another 2 weeks (23 patients). Clinical outcome was assessed during a 12-month follow-up period.


RESULTS
Improvement in the frequency and/or the intensity of symptoms was reported by more than two-thirds of the 46 patients enrolled in the study. The two treatment regimens were found to be correspondingly effective. Photosensitivity reactions and gastrointestinal symptoms were noted more often among patients receiving doxycycline than in those receiving ceftriaxone. Treatment with doxycycline proved to be much cheaper than with ceftriaxone.


CONCLUSIONS
In patients with previously untreated chronic Lyme borreliosis with symptoms suggesting central nervous system involvement but without overt clinical signs of it, and without pleocytosis in the cerebrospinal fluid, treatment with doxycycline is as effective as with ceftriaxone. Treatment with doxycycline is cheap and relatively safe, but gastrointestinal symptoms and photosensitivity reactions can be expected more often than with ceftriaxone.
Ogrinc
Katarina
K
Department of Infectious Diseases, University Medical Center Ljubljana, Slovenia. katarina.ogrinc1@guest.arnes.si
Logar
Mateja
M
Lotric-Furlan
Stanka
S
Cerar
Dasa
D
Ruzić-Sabljić
Eva
E
Strle
Franc
F
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000907:Antibodies, Bacterial / Q000032:analysis; D025065:Borrelia burgdorferi / Q000276:immunology / Q000302:isolation & purification; D002443:Ceftriaxone / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D004318:Doxycycline / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000032:analysis; D007075:Immunoglobulin M / Q000032:analysis; D007275:Injections, Intravenous; D008193:Lyme Disease / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D002443:Ceftriaxone; D004318:Doxycycline