A randomized trial of ceftriaxone versus oral penicillin for the treatment of early european lyme borreliosis

Abstract

In a prospective randomized multicenter trial for the therapy of erythema migrans, 40 patients received ceftriaxone 1 g daily for 5 days and 33 patients obtained phenoxymethylpenicillin, 1 million units 3 times daily, for 12 days. Follow-up was for a mean of 10 +/- 5 months. Eight oral penicillin recipients (24%) and six ceftriaxone recipients (15%) developed minor consecutive manifestations. Two ceftriaxone and one penicillin recipient(s) still had elevated IgG antibody titers 10 to 20 months after therapy. Borrelia burgdorferi could be isolated from the erythema migrans in 29 out of 56 patients (52%) before therapy and in one oral penicillin recipient but none of 24 other patients after therapy. Ceftriaxone was superior to oral penicillin in a subgroup of patients with more than one symptom prior to therapy (p less than 0.01), but not in the overall evaluation of clinical, serological and bacteriological outcome data. Ceftriaxone ought to be preferred to oral penicillin in patients with more severe early Lyme borreliosis.

Chronic Lyme Disease: A Review

“…The most common postLyme disease symptoms are fatigue, arthralgias, myalgias, headache, neck stiffness, paresthesias, sleeplessness, irritability, and difficulty with memory, word finding, and concentration [12,13,[25][26][27][28]. The appearance of post-Lyme disease symptoms seems to correlate with disseminated disease, a greater severity of illness at presentation, and delayed antibiotic therapy [12,[29][30][31][32][33]; but not with the duration of the initial antibiotic therapy [13,23]. Children appear to be less likely to develop post-Lyme disease symptoms [34][35][36][37][38][39][40][41][42].…”

“…A review of the earliest studies of patients with Lyme disease demonstrate the uncertainty that surrounded the disease and explain in part some of the confusion regarding "chronic Lyme disease". During those initial years, nonspecific symptoms were classified as part of "minor" late manifestations or complications of Lyme disease, to differentiate from the "major" manifestations, which included arthritis, meningoencephalitis and carditis [25,[29][30][31]. In some cases, facial palsy and brief episodes of arthritis were grouped together with nonspecific symptoms as part of minor manifestations of late Lyme disease [29,30], and, in some studies, all patients were grouped together [29,31].…”

“…During those initial years, nonspecific symptoms were classified as part of "minor" late manifestations or complications of Lyme disease, to differentiate from the "major" manifestations, which included arthritis, meningoencephalitis and carditis [25,[29][30][31]. In some cases, facial palsy and brief episodes of arthritis were grouped together with nonspecific symptoms as part of minor manifestations of late Lyme disease [29,30], and, in some studies, all patients were grouped together [29,31]. While arthritis, meningoencephalitis, carditis and other objective manifestations of Lyme disease are clear evidence of treatment failure and require antibiotic therapy [14], there was uncertainty about whether nonspecific "minor" symptoms could also represent treatment failures and that longer courses of antibiotics or different antibiotic regimens may be needed in some of the patients [30,31,52,53].…”

Efficacy of Short-Course Ceftriaxone Therapy for Borrelia burgdorferi Infection in C3H Mice

“…However, it is interesting that Weber et al (18) successfully treated a group of German patients with erythema migrans with single daily 1-g doses of ceftriaxone administered for just 5 days. Rigorous clinical trials are needed to determine more precisely the appropriate duration of antibiotic therapy for patients with early uncomplicated Lyme disease.…”

Chronic Lyme disease: the controversies and the science

“…Since the earliest treatment trials of Lyme disease, the factor that has most consistently predicted persistence of symptoms is their severity before initiation of therapy [113][114][115]. Severe headache, arthritis, arthralgias and fatigue at presentation predicted persistent symptoms in a retrospectively examined cohort of 215 patients [116].…”