Azithromycin and doxycycline for treatment of Borrelia 41culture-positive erythema migrans.

  Infection. 1996 Jan-Feb;24,1:64-8. Azithromycin and doxycycline for treatment of Borrelia
41culture-positive erythema migrans. Strle F, Maraspin V, Lotric-Furlan S, Ruzi·-Sablji· E, 
Cimperman J.
Dept. of Infectious Diseases, University Medical Centre Ljubljana, Japlijeva, Slovenia.
Adult patients with typical solitary erythema migrans, participating in prospective therapeutic 
studies on early Lyme borreliosis at the Lyme borreliosis Outpatient's Clinic, University 
Department of Infectious Diseases in Ljubljana, in 1991 to 1993, and followed up for 1 year, 
were included in the study. Only patients who were treated with azithromycin or doxycycline
and in whom Borrelia burgdorferi was isolated from the border of the skin lesion prior to 
institution of antibiotic treatment were selected for presentation in this report. Fifty-eight 
patients received azithromycin, 500 mg twice daily for the first day, followed by 500 mg once 
daily for 4 days, and 42 patients received doxycycline, 100 mg twice daily for 14 days. The median 
duration of skin lesions after the beginning of treatment was 6.5, 2-30, days in the azithromycin
group and 8, 2-35, days in the doxycycline group, non-significant 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, 20, 15.5%, 
treated with azithromycin and in ten, 23.8%, receiving doxycycline. In one patient in the 
azithromycin group and in one patient in the doxycycline group B. burgdorferi was isolated 
from normal appearing skin at the site of previous erythema migrans 2 months after the 
institution of antibiotic therapy. Five, 8.6%, patients receiving azithromycin and nine, 21.4%, 
patients receiving doxycycline reported mild to moderate gastrointestinal discomfort. In 
addition, five patients treated with doxycycline developed photosensitivity

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