Summary
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<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.
Zusammenfassung
In einer prospektiven, randomisierten Multizenter-Studie zur Therapie des Erythema migrans wurden 40 Patienten mit täglich 1 g Ceftriaxon intramuskulär über fünf Tage und 33 Patienten mit täglich 3 × 1 Mill. I. E. Phenoxymethylpenicillin über 12 Tage behandelt. Die Nachbeobachtung betrug durchschnittlich 10±5 Monate. Acht mit Penicillin (24%) und sechs mit Ceftriaxon behandelte Patienten (15%) entwickelten leichtere spätere Manifestationen. Zwei mit Ceftriaxon und ein mit Penicillin Behandelter wiesen erhöhte IgG Antikörper-Titer 10 bis 20 Monate nach Therapie auf.Borrelia burgdorferi konnte bei 29 von 56 Patienten (52%) vor und bei einem Patienten der Penicillingruppe, aber bei keinem Patienten der Ceftriaxongruppe nach Behandlung aus dem Erythema migrans isoliert werden. Ceftriaxon war dem Oral-Penicillin bei einer Untergruppe von Patienten mit mehr als einem Symptom vor Therapie überlegen (p<0,01), aber nicht bei der Gesamtauswertung klinischer, serologischer und bakteriologischer Erfolgsdaten. Ceftriaxon sollte dem oralen Penicillin bei Patienten mit schwererer früher Lyme-Borreliose vorgezogen werden.
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Weber, K., Preac-Mursic, V., Wilske, B. et al. A randomized trial of ceftriaxone versus oral penicillin for the treatment of early european lyme borreliosis. Infection 18, 91–96 (1990). https://doi.org/10.1007/BF01641422
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DOI: https://doi.org/10.1007/BF01641422