ERYTHEMA MIGRANS - 3 WEEKS TREATMENT FOR PREVENTION OF LATE LYME BORRELIOSIS

An open, randomized, prospective study was carried out to compare the clinical efficacy and safety of phenoxymethylpenicillin with that of m inocycline in the treatment of erythema migrans. Sixty patients (minoc ycline 30, penicillin 30) were enrolled in the study. The two groups o f patients were statistically homogeneous regarding age and sex distri bution. IgG and IgM antibodies against Borrelia burgdorferi were deter mined by ELISA before and after treatment and 1 year thereafter. Thirt y-nine patients completed the study. All these patients (penicillin 21 , minocycline 18) who received a 21-day course of treatment were free of clinical symptoms of late Lyme borreliosis after 1 year. Serum anti bodies against B. burgdorferi could be detected before treatment in 6/ 21 patients treated with penicillin and 3/18 patients treated with min ocycline. After 1 year 8/39 patients were seropositive without any evi dence of ongoing disease. In the remaining 21 patients treatment could not be completed with the initial antibiotic due to side effects (pen icillin 9/30, minocycline 12/30). One patient, who stopped penicillin treatment at day 14 and one patient who stopped minocycline at day 4, developed fatigue and memory impairment within the observation period. A 3-week course of treatment with penicillin or minocycline is equall y effective in treating patients with erythema migrans and preventing late symptoms of Lyme borreliosis.