AZITHROMYCIN AND DOXYCYCLINE FOR TREATMENT OF BORRELIA CULTURE-POSITIVE ERYTHEMA MIGRANS

Adult patients with typical solitary erythema migrans, participating i n prospective therapeutic studies on early Lyme borreliosis at the Lym e borreliosis Outpatient's Clinic, University Department of Infectious Diseases in Ljubljana, in 1991 to 1993, and followed up for 1 year, w ere included in the study. Only patients who were treated with azithro mycin or doxycycline and in whom Borrelia burgdorferi was isolated fro m the border of the skin lesion prior to institution of antibiotic tre atment were selected for presentation in this report. Fifty-eight pati ents received azithromycin (500 mg twice daily for the first day, foll owed by 500 mg once daily for 4 days) and 42 patients received doxycyc line (100 mg twice daily for 14 days). The median duration of skin les ions after the beginning of treatment was 6.5 (2-30) days in the azith romycin group and 8 (2-35) days in the doxycycline group (nonsignifica nt difference). During the follow-up of 12 months one patient in each group developed major later manifestations of Lyme borreliosis and in 19 patients minor manifestations appeared: in nine (15.5%) treated wit h azithromycin and in ten (23.8%) receiving doxycycline. In one patien t in the azithromycin group and in one patient in the doxycycline grou p B, burgdorferi was isolated from normal appearing skin at the site o f previous erythema migrans 2 months after the institution of antibiot ic therapy Five (8.6%) patients receiving azithromycin and nine (21.4% ) patients receiving doxycycline reported mild to moderate gastrointes tinal discomfort. In addition, five patients treated with doxycycline developed photosensitivity.