tetracycline and Erythema-Chronicum-Migrans

Doxycycline is widely used to treat Lyme disease associated with erythema migrans. Whether it is comparable to tetracycline is unknown.. We conducted a two-part retrospective analysis of (1) the safety and efficacy of doxycycline compared with tetracycline and (2) the safety and efficacy of a 14-day versus a 20-day course of doxycycline.. Twenty-seven patients given tetracycline (500 mg four times a day for 14 days [group 1]) were compared retrospectively with 21 patients who received doxycycline (100 mg two or three times a day for 14 days [group 2]). The results for group 2 were also compared with that of 38 patients who received doxycycline for 20 days (100 mg three times daily) in a prospective treatment trial (group 3).. There was no significant difference in the incidence of adverse drug effects or in efficacy at 1 month, but at 1 year there was a trend toward a better outcome in the group treated with tetracycline (p = 0.08). A 14-day course of doxycycline was comparable to a 20-day course in the incidence of adverse drug effects and in clinical outcome.. The principal advantage of doxycycline over tetracycline for the treatment of Lyme disease associated with erythema migrans is the convenience of less frequent dosing, not enhanced efficacy or safety. There appears to be no advantage in extending treatment with doxycycline from 14 to 20 days.

Topics: Administration, Oral; Adult; Age Factors; Doxycycline; Drug Administration Schedule; Erythema Chronicum Migrans; Female; Follow-Up Studies; Humans; Lyme Disease; Male; Middle Aged; Nausea; Photosensitivity Disorders; Prospective Studies; Retrospective Studies; Safety; Tetracycline; Treatment Outcome

To determine whether early dissemination of Borrelia burgdorferi to the central nervous system occurs in stage I of Lyme borreliosis, neurological and cerebrospinal fluid examination was performed in 48 consecutive patients in whom the only sign of infection was a solitary erythema migrans lesion. Long-term follow-up after treatment with tetracycline was carried out by telephone interview. At presentation, neurological findings were normal in all 48 patients. Cerebrospinal fluid samples were obtained from 29 (60%) patients. Mild pleocytosis and mild impairment of the blood-brain barrier were present in four and one of these patients, respectively. No significant amount of tumor necrosis factor or interleukin 6 was found in the cerebrospinal fluid samples. Culture results of 13 cerebrospinal fluid samples were negative. Borrelia burgdorferi DNA was only detected by the polymerase chain reaction in one of two aliquots of the cerebrospinal fluid sample of one patient. None of 46 patients who were interviewed 12 to 51 (median 25) months after antibiotic treatment developed manifestations consistent with disseminated or chronic Lyme borreliosis. Thus, no compelling evidence was found for the presence of asymptomatic central nervous system involvement in patients with clinically localized Lyme borreliosis.

Topics: Adult; Aged; Borrelia burgdorferi Group; Central Nervous System Diseases; Erythema Chronicum Migrans; Female; Follow-Up Studies; Humans; Interleukin-6; Lyme Disease; Male; Middle Aged; Polymerase Chain Reaction; Prospective Studies; Serologic Tests; Tetracycline; Tumor Necrosis Factor-alpha

Regional variations in the clinical spectrum of Lyme borreliosis have been described previously. These may be related to strain variations, or reflect selection bias. We compared the clinical and epidemiological profiles of Dutch patients presenting with solitary erythema migrans alone, with the profiles in other European studies, and studies from the U.S.A., and cultured Borrelia burgdorferi from erythema migrans to identify the genospecies. Seventy-seven consecutive patients with a final diagnosis of erythema migrans were admitted into the study. Various clinical and epidemiological data were obtained, and serum was evaluated for antibodies to Borrelia burgdorferi with an enzyme-linked immunosorbent assay. Skin biopsy specimens were taken from the border of the erythema migrans and cultured in modified Kelly's medium. The different genospecies of Borrelia burgdorferi were identified by reactivity with monoclonal antibodies H3TS, LA-26, LA-31 and D6, and by rRNA gene restriction patterns. Patients were treated with tetracycline or doxycycline, and were seen for follow-up 6 weeks after treatment. Long-term follow-up was by telephone interview. A tick bite had been noticed by 45% of the patients. The onset of erythema migrans occurred in 97% of these patients within 3 months of the tick bite. Erythema migrans was present for 1-319 days (median 2 months). No concomitant manifestations were spontaneously reported. Borrelia burgdorferi was cultured from 52 (84%) of 62 skin biopsy specimens. Fifty isolates (96%) were identified as Borrelia burgdorferi group VS461. No therapy failures occurred among patients treated with tetracycline (follow-up 1-4 years, median 27 months) or doxycycline (follow-up 6-31 months, median 19 months).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Antibodies, Bacterial; Borrelia burgdorferi Group; Child; Child, Preschool; Doxycycline; Erythema Chronicum Migrans; Female; Follow-Up Studies; Humans; Male; Middle Aged; Netherlands; Prospective Studies; Skin; Tetracycline

Erythema migrans recurred in a patient 6 months after a course of treatment with minocycline for Lyme disease. Polymerase chain reaction on heparinized peripheral blood at that time demonstrated the presence of Borrelia burgdorferi-specific DNA. The patient was seronegative by Lyme enzyme-linked immunosorbent assay but showed suspicious bands on Western blot. Findings of a Warthin-Starry stain of a skin biopsy specimen of the eruption revealed a Borrelia-compatible structure. Reinfection was not believed to have occurred. Further treatment with minocycline led to resolution of the erythema migrans.

Topics: Aged; Erythema Chronicum Migrans; Female; Humans; Lyme Disease; Minocycline; Recurrence; Tetracycline

A 66 year old woman with a history suggesting a tick bite on the right arm developed a slowly expanding erythematosus lesion. Similar lesions appeared on the trunk and extremities in the following months. A skin biopsy showing spiral shaped agents and the clinical findings were compatible with erythema chronicum migrans. A course of penicillin resulted in complete resolution of the lesions. After a 2 year follow up period she remains free of rheumatic, neurologic or cardiac lesions of Lyme's disease.

Topics: Aged; Erythema Chronicum Migrans; Female; Humans; Lyme Disease; Penicillin G; Penicillin G Benzathine; Tetracycline

Topics: Anti-Bacterial Agents; Erythema; Erythema Chronicum Migrans; Humans; Protein Synthesis Inhibitors; Rickettsia Infections; Tetracycline