CEFTRIAXONE COMPARED WITH DOXYCYCLINE FOR THE TREATMENT OF ACUTE DISSEMINATED LYME-DISEASE

Background Localized Lyme disease, manifested by erythema migrans, is usually treated with oral doxycycline or amoxicillin. Whether acute di sseminated Borrelia burgdorferi infection should be treated differentl y from localized infection is unknown. Methods We conducted a prospect ive, open-label, randomized, multicenter study comparing parenteral ce ftriaxone (2 g once daily for 14 days) with oral doxycycline (100 mg t wice daily for 21 days) in patients with acute disseminated B. burgdor feri infection but without meningitis. The erythema migrans skin lesio n was required for study entry, and disseminated disease had to be ind icated by either multiple erythema migrans lesions or objective eviden ce of organ involvement. Results Of 140 patients enrolled, 133 had mul tiple erythema migrans lesions. Both treatments were highly effective. Rates of clinical cure at the last evaluation were similar among the patients treated with ceftriaxone (85 percent) and those treated with doxycycline (88 percent); treatment was considered to have failed in o nly one patient in each group. Among patients whose infections were cu red, 18 of 67 patients in the ceftriaxone group (27 percent) reported one or more residual symptoms at the last follow-up visit, as did 10 o f 71 patients in the doxycycline group (14 percent, P greater than or equal to 0.05). Mild arthralgia was the most common persistent symptom . Both regimens were well tolerated; only four patients (6 percent) in each group withdrew because of adverse events. Conclusions In patient s with acute disseminated Lyme disease but without meningitis, oral do xycycline and parenterally administered ceftriaxone were equally effec tive in preventing the late manifestations of disease. (C) 1997, Massa chusetts Medical Society.