Abstract
A randomized, multicenter, investigator-blinded clinical trial was undertaken in order to compare the efficacies of cefuroxime axetil and doxycycline in the treatment of patients with Lyme disease associated with erythema migrans. A total of 232 patients with physician-documented erythema migrans were treated orally for 20 days with either cefuroxime axetil, 500 mg twice daily (119 patients), or doxycycline, 100 mg three times daily (113 patients), and clinical evaluations were conducted during treatment (8 to 12 days) and at 1 to 5 days and 1, 3, 6, 9, and 12 months posttreatment. Patients were assessed as to the resolution of erythema migrans and of the signs and symptoms related to early Lyme disease as well as to the prevention of late Lyme disease. A satisfactory clinical outcome (success or improvement) was achieved in 90 of 100 (90%) evaluable patients treated with cefuroxime axetil and in 89 of 94 (95%) patients treated with doxycycline (difference, -5%; 95% confidence interval, -12 to 3%). Patients with paresthesia, arthralgia, or irritability at enrollment were at higher risk for an unsatisfactory clinical outcome at 1 month posttreatment. Of the patients with satisfactory outcomes at 1 month posttreatment who were evaluable at 1 year posttreatment, a satisfactory outcome was achieved in 62 of 65 (95%) and in 53 of 53 (100%) patients treated with cefuroxime axetil and doxycycline, respectively (difference, -5%; 95% confidence interval, -10 to 4%). Twenty-eight percent of patients treated with doxycycline and 17% of those treated with cefuroxime axetil had one or more drug-related adverse events (P = 0.041). Doxycycline was associated with more photosensitivity reactions (6% compared with 0% for patients treated with cefuroxime axetil; P=0.006), and cefuroxime axetil was associated with more cases of diarrhea (5% compared with 0% for patients treated with doxycycline; P=0.030). Jarisch-Herxheimer reactions occurred in 12% of the patients in each treatment group. In summary, cefuroxime axetil is well tolerated and appears to be equally as effective as doxycycline in the treatment of early Lyme disease and in preventing the subsequent development of late Lyme disease.
Full Text
The Full Text of this article is available as a PDF (203.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Agger W. A., Callister S. M., Jobe D. A. In vitro susceptibilities of Borrelia burgdorferi to five oral cephalosporins and ceftriaxone. Antimicrob Agents Chemother. 1992 Aug;36(8):1788–1790. doi: 10.1128/aac.36.8.1788. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dattwyler R. J., Volkman D. J., Conaty S. M., Platkin S. P., Luft B. J. Amoxycillin plus probenecid versus doxycycline for treatment of erythema migrans borreliosis. Lancet. 1990 Dec 8;336(8728):1404–1406. doi: 10.1016/0140-6736(90)93103-v. [DOI] [PubMed] [Google Scholar]
- Emmerson A. M. Cefuroxime axetil. J Antimicrob Chemother. 1988 Aug;22(2):101–104. doi: 10.1093/jac/22.2.101. [DOI] [PubMed] [Google Scholar]
- Finn A., Straughn A., Meyer M., Chubb J. Effect of dose and food on the bioavailability of cefuroxime axetil. Biopharm Drug Dispos. 1987 Nov-Dec;8(6):519–526. doi: 10.1002/bdd.2510080604. [DOI] [PubMed] [Google Scholar]
- HOLLSTROM E. Successful treatment of erythema migrans Afzelius. Acta Derm Venereol. 1951;31(2):235–243. [PubMed] [Google Scholar]
- Johnson R. C., Kodner C. B., Jurkovich P. J., Collins J. J. Comparative in vitro and in vivo susceptibilities of the Lyme disease spirochete Borrelia burgdorferi to cefuroxime and other antimicrobial agents. Antimicrob Agents Chemother. 1990 Nov;34(11):2133–2136. doi: 10.1128/aac.34.11.2133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Krause P. J., Telford S. R., 3rd, Ryan R., Hurta A. B., Kwasnik I., Luger S., Niederman J., Gerber M., Spielman A. Geographical and temporal distribution of babesial infection in Connecticut. J Clin Microbiol. 1991 Jan;29(1):1–4. doi: 10.1128/jcm.29.1.1-4.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marx M. A., Fant W. K. Cefuroxime axetil. Drug Intell Clin Pharm. 1988 Sep;22(9):651–658. doi: 10.1177/106002808802200901. [DOI] [PubMed] [Google Scholar]
- Massarotti E. M., Luger S. W., Rahn D. W., Messner R. P., Wong J. B., Johnson R. C., Steere A. C. Treatment of early Lyme disease. Am J Med. 1992 Apr;92(4):396–403. doi: 10.1016/0002-9343(92)90270-l. [DOI] [PubMed] [Google Scholar]
- Nadelman R. B., Luger S. W., Frank E., Wisniewski M., Collins J. J., Wormser G. P. Comparison of cefuroxime axetil and doxycycline in the treatment of early Lyme disease. Ann Intern Med. 1992 Aug 15;117(4):273–280. doi: 10.7326/0003-4819-117-4-273. [DOI] [PubMed] [Google Scholar]
- Steere A. C., Dwyer E., Winchester R. Association of chronic Lyme arthritis with HLA-DR4 and HLA-DR2 alleles. N Engl J Med. 1990 Jul 26;323(4):219–223. doi: 10.1056/NEJM199007263230402. [DOI] [PubMed] [Google Scholar]
- Steere A. C., Grodzicki R. L., Kornblatt A. N., Craft J. E., Barbour A. G., Burgdorfer W., Schmid G. P., Johnson E., Malawista S. E. The spirochetal etiology of Lyme disease. N Engl J Med. 1983 Mar 31;308(13):733–740. doi: 10.1056/NEJM198303313081301. [DOI] [PubMed] [Google Scholar]
- Steere A. C., Hutchinson G. J., Rahn D. W., Sigal L. H., Craft J. E., DeSanna E. T., Malawista S. E. Treatment of the early manifestations of Lyme disease. Ann Intern Med. 1983 Jul;99(1):22–26. doi: 10.7326/0003-4819-99-1-22. [DOI] [PubMed] [Google Scholar]
- Steere A. C., Malawista S. E., Newman J. H., Spieler P. N., Bartenhagen N. H. Antibiotic therapy in Lyme disease. Ann Intern Med. 1980 Jul;93(1):1–8. doi: 10.7326/0003-4819-93-1-1. [DOI] [PubMed] [Google Scholar]