Oral doxycycline versus intravenous ceftriaxone for European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blind, randomised trial

Ljøstad, Unn; Skogvoll, Eirik; Eikeland, Randi; Midgard, Rune; Skarpaas, Tone; Berg, Åse; Mygland, Åse

doi:10.1016/s1474-4422(08)70119-4

Cited by 233 publications

(129 citation statements)

References 25 publications

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“…In a study by Lauhio and co-workers [23] it was shown that three month lymecycline has a favorable effect in acute chlamydia arthritis and recently it was demonstrated that six months combination therapy of two antibiotics is efficient in chronic chlamydia arthritis [24]. Single antibiotic therapy with doxycycline in disseminated LB has shown relatively low cure rates, as has been shown in studies by Borg and colleagues [25], Orgnic and coworkers [26] as well as by Ljøstad and co-workers [27]. Thus, one possibility to achieve better cure rates could be to use a combination therapy of doxycycline and intravenous ceftriaxone, at least to the subgroup of patients with persistent symptoms after ceftriaxone treatment.…”

Section: Figure 4 (A)mentioning

confidence: 87%

Serum Matrix Metalloproteinase-8 and -9 Levels in Disseminated Lyme Borreliosis with Special Reference to Arthritis

Lauhio¹,

Oksi²,

Tervahartiala³

et al. 2012

BIO

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Recent evidence suggests that matrix metalloproteinases (MMPs) are involved in pathogenesis of Lyme borreliosis (LB). We studied serum levels of MMP-8 and MMP-9 in disseminated LB patients with special reference to arthritis. Serum MMP-8 and-9 levels were analyzed by enzyme-linked immunoabsorbent assay from 110 patients from our previous multicenter, prospective study. Serum samples were taken before betalactam antibiotic treatment at study entry and after antibiotic treatment, at 1 year follow-up.Among disseminated LB patients (n = 110) mean (± SEM) serum MMP-8 and -9 levels (ng/ml) at study entry were statistically significantly higher than at 1 year follow-up (28.0 ± 1.9 versus 23.1 ± 1.6, P = 0.0313 and 398.0 ± 22.7 vs. 334.3 ± 23.6, P = 0.0219, respectively). Among Lyme arthritis (LA) patients (n = 34) at study entry serum MMP-8, but not MMP-9, levels decreased significantly when compared to serum levels of those at 1 year follow-up (35.7 ± 4.4 vs. 22.4 ± 2.3, P = 0.0093 and 398.6 ± 44.1 vs. 297.8 ± 40.3, P = 0.0505, respectively). The mean (± SEM) serum levels (ng/ml) of MMP-8 were significantly higher after betalactam antibiotic treatment at 1 year follow-up among antibiotic resistant LA patients with poor response than among those LA patients who were totally recovered (32.8 ± 6.4 vs. 20.1 ± 2.3, P = 0.0376). In contrast, the mean (± SEM) serum levels (ng/ml) of MMP-9 of antibiotic resistant LA patients showed no statistical significant difference when compared to those LA patients who were totally recovered at 1 year follow-up (297.8 ± 40.3 vs. 396.8 ± 93.9, P = 0.80).In conclusion, our results suggest that serum MMP-8 levels are excessively upregulated in disseminated LB contributing to inflammatory response, and related to persistent joint symptoms. This novel finding may offer in the future new laboratory possibilities to diagnose patients with persistent symptoms after betalactam antibiotic treatment. In addition the present findings suggest that to improve the outcome of disseminated borreliosis, the therapy of disseminated LB should include MMP-8 inhibitor such as doxycycline, possibly in combination therapy such as a combination of ceftriaxone and doxycycline. BIO © [2012], Copyright CCAAS Anneli Lauhio, et. al., BIO 2012, 2, 68-74 69 http://ccaasmag.org/BIO

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Section: Figure 4 (A)mentioning

confidence: 87%

Serum Matrix Metalloproteinase-8 and -9 Levels in Disseminated Lyme Borreliosis with Special Reference to Arthritis

Lauhio¹,

Oksi²,

Tervahartiala³

et al. 2012

BIO

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“…None of the eight patients with definite or possible Lyme neuroborreliosis had had a rash suspected of being erythema migrans, and only two recalled a tick bite within the last three months. It is known that about half of patients with Lyme neuroborreliosis do not recall either a tick bite or erythema migrans (7,28). Lyme neuroborreliosis is thus an important differential diagnosis in cases of newonset peripheral facial nerve palsy, irrespective of whether the patient can recall a tick bite or erythema migrans.…”

Section: Discussionmentioning

confidence: 99%

Lyme-nevroborreliose ved uspesifikke nevrologiske symptomer

Roaldsnes¹,

Eikeland²,

Berild³

2017

Tidsskriftet

Self Cite

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“…There are good data showing that oral doxycycline is not inferior to intravenous ceftriaxone (Rocephin) in patients with cranial neuritis, radiculitis and meningitis. 13 Where there is encephalo myelitis there are insufficient data to indicate that oral therapy is not inferior and therefore an intravenous regimen is preferred (see Table 2). 14,15 The outcome following treatment is variable with age, duration of symptoms and severity of meningeal inflammation all influencing recovery.…”

Section: Treatment and Outcomementioning

confidence: 99%

“…Follow-up of 102 appropriately treated patients in Norway found that 70 per cent had complete resolution of signs four months after treatment, with the remainder showing improvement. 13 …”

Section: Treatment and Outcomementioning

confidence: 99%

Diagnosis, treatment and prevention of Lyme borreliosis

Cochrane¹,

Williams²

2011

Prescriber

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In Scotland, where Lyme borreliosis is notifiable, transmission is well recognised across the country with an incidence is 5.9 per 100 000 nationally, increasing to 43 per 100 000 in the Highlands. 4 Clinical manifestationsThe clinical manifestations of Lyme borreliosis are multiple and the natural histor y varied, but an understanding of the pathogenesis allows the disease to be viewed in three stages. In the first stage there is multiplication and local invasion of Borrelia spp. at the site of inoculation. In some people this is asymptomatic, while in others it causes erythema migrans, systemic symptoms (myalgia, headache, arthralgia, fatigue) or both.In the second stage there is dissemination and seeding of distant tissue manifesting commonly as nervous system disease or rarely as carditis. These early features of disseminated disease often overlap temporally with the local manifestations and these two stages have been termed 'early Lyme borreliosis'. As early Lyme borreliosis may manifest before seroconversion, negative acute serology does not rule out the diagnosis (see Table 1).The third stage, often termed 'late Lyme borreliosis', comprises later manifestations of dissemination occurring more than six months after infection, including arthritis, skin involvement and very rarely eye and late nervous system disease. It is fear of these late manifestations that is often of most con-50 Prescriber 5 March 2011 www.prescriber.co.uk antibody production synovial fluid or 95% in >99% (clean on discussion with reference laboratory biopsy for PCR previously lab) only untreated * These sensitivities and specificities were provided by Dr S O'Connel (HPA Lyme Diseases Reference Laboratory, Southampton) and are correct for that laboratory; the figures should not be used to interpret tests from unregulated laboratories. Sensitivity varies with duration of infection and infecting organism, with Borrelia burgdorferi sensu strictu triggering a more brisk response than Borrelia afzelii. PCR = polymerase chain reaction Prescribing in practice

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Oral doxycycline versus intravenous ceftriaxone for European Lyme neuroborreliosis: a multicentre, non-inferiority, double-blind, randomised trial

Cited by 233 publications

References 25 publications

Serum Matrix Metalloproteinase-8 and -9 Levels in Disseminated Lyme Borreliosis with Special Reference to Arthritis

Serum Matrix Metalloproteinase-8 and -9 Levels in Disseminated Lyme Borreliosis with Special Reference to Arthritis

Lyme-nevroborreliose ved uspesifikke nevrologiske symptomer

Diagnosis, treatment and prevention of Lyme borreliosis

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