Comparison of cefuroxime axetil and phenoxymethyl penicillin for the treatment of children with solitary erythema migrans

'Objective: To compare the clinical efficacy and drug-related adverse effec ts of 14 days of treatment with cefuroxime axetil 30 mg/kg/day or phenoxyme thyl penicillin 100 000 IU/kg/day in the treatment of children with erythem a migrans. Methods: Consecutive patients younger than 15 years, referred to our instit ution in 1996 with solitary erythema migrans and without prior antibiotic t herapy, were included in this prospective study. Basic demographic features and clinical data were collected by questionnaire. The efficacy of the tre atment of acute disease, development of major and/or minor manifestations o f Lyme borreliosis and drug-related adverse effects were surveyed at follow -up visits during the first year after the initiation of antibiotic treatme nt. Results: Forty-six patients received cefuroxime axetil (group C) and 44, ph enoxymethyl penicillin (group P). The two groups differed in terms of age ( patients in group C were younger), but no other differences in demographic and clinical pre-treatment characteristics were present. The clinical cours e during the post-treatment period revealed no significant differences betw een the two groups: the duration of erythema migrans (7.1 +/- 7.5 days in g roup C, 10.6 +/- 19.3 days in group P) and the appearance of minor manifest ations of Lyme borreliosis (8.8% in group C, 9.1% in group P) were comparab le; no major manifestations were recorded. Twelve months after antibiotic t reatment all patients were free of symptoms. The patients treated with cefu roxime axetil had more drug-related adverse effects than did those treated with phenoxymethyl penicillin (26.1% versus 6.8%, p=0.0301). "Herxheimer's reaction" at the beginning of treatment was identified more often in group C than in group P, but the difference was not statistically significant. Conclusions: Cefuroxime axetil and phenoxymethyl penicillin are equally eff ective in the treatment of children with solitary erythema migrans; however drug-related adverse effects were more frequently observed with cefuroxime axetil.