, Volume 21, Issue 2, pp 83–88 | Cite as

Azithromycin versus doxycycline for treatment of erythema migrans: Clinical and microbiological findings

  • F. Strle
  • J. Cimperman
  • Vera Maraspin
  • M. Jereb
  • Vera Preac-Mursic
  • Eva Ružič


The effectiveness of azithromycin and doxycycline in the treatment of erythema migrans was compared in a prospective randomized trial. One hundred seven adult patients with typical erythema migrans, examined in the Lyme Borreliosis Outpatients' Clinic, University Department of Infectious Diseases in Ljubljana, were included in the study. Fifty-five patients received azithromycin (500 mg twice daily for the first day, followed by 500 mg once daily for four days) and 52 patients received doxycycline (100 mg twice daily for 14 days). The mean duration of skin lesions after the beginning of treatment was 7.5±5.9 days (median value 5, range 2–28 days) in the azithromycin group and 11.4±7.8 days (median value 9, range 2 days — 8 weeks) in the doxycycline group (p<0.05).Borrelia burgdorferi was isolated from erythema migrans in 28 patients before therapy: in 13 out of 52 in the doxycycline group and in 15 out of 55 in the azithromycin group. Three months after therapy, the culture was positive in four out of 13 patients treated with doxycycline and in one of the 15 patients who received azithromycin. A biopsy was repeated in all the patients with a positive isolation from the first skin specimen. During the first 12 months' follow-up, three patients treated with doxycycline but none in the azithromycin group developed major manifestations of Lyme borreliosis, while 15 doxycycline recipients and 10 azithromycin recipients developed minor consecutive manifestations.


Doxycycline Azithromycin Borrelia Burgdorferi Lyme Borreliosis Positive Isolation 
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Azithromycin versus Doxycyclin bei Erythema migrans: klinische und mikrobiologische Befunde


In einer prospektiven, randomisierten Studie wurde die Wirksamkeit von Azithromycin und Doxycyclin bei Erythema migrans verglichen. In die Studie, die in der Lyme-Borreliose-Ambulanz der Infektiologischen Abteilung der Universtitätsklinik Ljubljana durchgeführt wurde, wurden 107 Patienten mit typischem Erythema migrans aufgenommen. Mit Azithromycin (500 mg zweimal täglich am ersten und 500 mg einmal täglich an den folgenden 4 Tagen) wurden 55 Patienten behandelt, mit Doxycyclin (200 mg zweimal täglich für 14 Tage) 52 Patienten. In der Azithromycin-Gruppe verschwanden die Hautläsionen nach Therapiebeginn im Mittel nach 7,5±5,9 (Medianwert 5; Bereich 2–28) Tagen, in der Doxycyclin-Gruppe nach 11,4±7,8 Tagen (Medianwert 9; Bereich 2 Tage bis 8 Wochen); (p<0,05). Bei 28 Patienten konnteBorrelia burgdorferi aus dem Bereich des Erythema migrans vor Therapiebeginn isoliert werden (13/52 Patienten der Doxycyclin-Gruppe und 15 von 55 Patienten der Azithromycin-Gruppe). Drei Monate nach Therapie waren die Kulturen in der Doxycyclin-Gruppe noch in vier von 13 und in der Azithromycin-Gruppe in einem von 15 Fällen positiv. Bei allen Patienten mit positiver Kultur in der ersten Hautbiopsie war auch eine Kontrollbiopsie vorgenommen und die Erregerisolierung durchgeführt worden. Während der ersten 12 Monate der Nachbeobachtungsphase hatten drei mit Doxycyclin behandelte Patienten bedeutende Manifestationsformen der Lyme Borreliose entwickelt. In der Azithromycin-Gruppe war dies in keinem Fall erfolgt. Weniger gravierende Manifestationsformen folgten bei 15 mit Doxycyclin und bei 10 mit Azithromycin behandelten Patienten.


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Copyright information

© MMV Medizin Verlag GmbH München 1993

Authors and Affiliations

  • F. Strle
    • 1
  • J. Cimperman
    • 1
  • Vera Maraspin
    • 1
  • M. Jereb
    • 1
  • Vera Preac-Mursic
    • 2
  • Eva Ružič
    • 3
  1. 1.Department of Infectious DiseasesUniversity Medical CenterLjubljanaSlovenia
  2. 2.Abt. für Mikrobiologie, Max von Pettenkofer InstitutUniversität MünchenMünchenGermany
  3. 3.Institute of MicrobiologyUniversity of LjubljanaLjubljanaSlovenia

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