zithromax and Erythema-Chronicum-Migrans

Human Lyme borreliosis is a multisystem disorder that can progress in stages and is transmitted by ticks of the Ixodes ricinus complex infected with the spirochete Borrelia burgdorferi sensu lato. Today, Lyme borreliosis is regarded as the most important human tickborne illness in the northern hemisphere. Soon after the causative agent was correctly identified and successfully isolated in 1982, antibiotic treatment was shown to be effective and since then a variety of in vitro and in vivo studies have been performed to further characterize the activity of antimicrobial agents against B. burgdorferi s.l. Although many antimicrobial agents have been tested for their in vitro activity against borreliae, the full spectrum of antibiotic susceptibility in B. burgdorferi s.l. has not been defined for many compounds. Moreover, our current understanding of possible antimicrobial resistance mechanisms in B. burgdorferi s.l. is limited and is largely founded on in vitro experiments on relatively few borrelial isolates. This review will summarize what is and what is not known about antimicrobial resistance in B. burgdorferi s.l. and will discuss open questions that continue to fuel the current debate on treatment-resistant Lyme borreliosis.

Topics: Adult; Aged; Amoxicillin; Anti-Bacterial Agents; Azithromycin; Borrelia burgdorferi Group; Calorimetry; Ceftriaxone; Cefuroxime; Drug Resistance, Bacterial; Erythema Chronicum Migrans; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Species Specificity; Time Factors

Topics: Amoxicillin; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Borrelia burgdorferi; Cephalosporins; Doxycycline; Erythema Chronicum Migrans; Humans; Lyme Disease; Penicillins; Polymerase Chain Reaction

Years before the spirochetal etiology of Lyme disease was determined, the effectiveness of antibiotic treatment for erythema chronicum migrans had been established. Revisions in antibiotic treatment have evolved in concert with a growing understanding of the pathogenesis of Lyme disease. Current treatment recommendations are discussed.

Topics: Adult; Animals; Anti-Bacterial Agents; Azithromycin; Borrelia burgdorferi Group; Cefuroxime; Child; Clinical Protocols; Clinical Trials as Topic; Erythema Chronicum Migrans; Humans; Lyme Disease; Microbial Sensitivity Tests; Prodrugs; Treatment Failure

To compare clinical effectiveness and side effects of treatment with azithromycin or phenoxymethylpenicillin in children with solitary erythema migrans.. Consecutive patients younger than 15 years, referred to our institution in 1998 and 1999 with previously untreated typical solitary erythema migrans, were included in this prospective study. Basic demographic features and clinical data were collected by means of a questionnaire. The efficiency of treatment of acute disease, development of later major and/or minor manifestations of Lyme borreliosis and side effects of treatment were surveyed by follow-up visits during the first year.. Forty-two patients received azithromycin 20 mg/kg/day for the first day followed by 10 mg/kg/day for a further four days and phenoxymethylpenicillin 100,000 IU/kg/day for 14 days. No differences in demographic and clinical pre-treatment characteristics were present in the two groups, with the exception of the duration of erythema migrans before treatment (3 days in the azithromycin group versus 4 days in the phenoxymethylpenicillin group; p = 0.0320). The clinical course during the post-treatment period revealed no significant differences between the two groups in the duration of EM (3 days versus 4 days; p = 0.2471), the appearance of minor manifestations of Lyme borreliosis (17.5% in the azithromycin group versus 24.4% in the phenoxymethyl-penicillin group; p = 0.6252), or in the emergence of major manifestations of Lyme borreliosis (one patient in each treatment group). One year after antibiotic treatment all patients were asymptomatic. Side effects of treatment were observed in 5.3% of patients treated with azithromycin and in 6% treated with phenoxymethylpenicillin. The appearance of "Herxheimer's reaction" at the beginning of treatment was recorded in 7 out of 42 patients (6%) in each treatment group.. Azithromycin and phenoxymethylpenicillin are equally effective in treatment of children with solitary erythema migrans and have comparable side effects.

Topics: Adolescent; Azithromycin; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Erythema Chronicum Migrans; Female; Humans; Infant; Male; Penicillin V; Slovenia; Treatment Outcome

To determine whether azithromycin or amoxicillin is more efficacious for the treatment of erythema migrans skin lesions, which are characteristic of Lyme disease.. Randomized, double-blind, double-dummy, multicenter study. Acute manifestations and sequelae were assessed using a standardized format. Baseline clinical characteristics and response were correlated with serologic results. Patients were followed for 180 days.. 12 outpatient centers in eight states.. 246 adult patients with erythema migrans lesions at least 5 cm in diameter were enrolled and were stratified by the presence of flu-like symptoms (such as fever, chills, headache, malaise, fatigue, arthralgias, and myalgias) before randomization.. Oral treatment with either amoxicillin, 500 mg three times daily for 20 days, or azithromycin, 500 mg once daily for 7 days. Patients who received azithromycin also received a dummy placebo so that the dosing schedules were identical.. Of 217 evaluable patients, those treated with amoxicillin were significantly more likely than those treated with azithromycin to achieve complete resolution of disease at day 20, the end of therapy (88% compared with 76%; P=0.024). More azithromycin recipients (16%) than amoxicillin recipients (4%) had relapse (P=0.005). A partial response at day 20 was highly predictive of relapse (27% of partial responders had relapse compared with 6% of complete responders; P<0.001). For patients treated with azithromycin, development of an antibody response increased the possibility of achieving a complete response (81% of seropositive patients achieved a complete response compared with 60% of seronegative patients; P=0.043). Patients with multiple erythema migrans lesions were more likely than patients with single erythema migrans lesions (P<0.001) to have a positive antibody titer at baseline (63% compared with 17% for IgM; 39% compared with 16% for IgG). Fifty-seven percent of patients who had relapse were seronegative at the time of relapse.. A 20-day course of amoxicillin was found to be an effective regimen for erythema migrans. Most patients were seronegative for Borrelia burgdorferi at the time of presentation with erythema migrans (65%) and at the time of relapse (57%).

Topics: Adult; Amoxicillin; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Double-Blind Method; Enzyme-Linked Immunosorbent Assay; Erythema Chronicum Migrans; Female; Humans; Male; Penicillins; Prospective Studies; Recurrence; Treatment Failure

We report a series of 28 consecutive patients with erythema migrans (EM) who underwent skin biopsies for culture of Borrelia burgdorferi. Culture results, Lyme serologic findings, and clinical features in patients with only primary EM are compared with those in patients with secondary EM.. Culture preparations of skin specimens obtained from six of 12 patients with only primary EM, and from 14 of 16 patients with secondary EM were positive for B burgdorferi. Seven patients with only primary EM were initially seronegative, and only one patient had an annular lesion. A central crusted punctum was present in five of six primary EM lesions that were not culture positive, but in none of nine culture-positive primary EM lesions. Patients with secondary EM were all seropositive and had less cutaneous and more constitutional symptoms than patients with only primary EM. Three patients with secondary EM had abnormal liver enzyme profiles, one patient had complete heart block, and one patient had myocarditis simulating infarction. Less than one third of all patients recalled a tick bite. An isomorphic nonresponse was seen in skin previously involved with secondary EM in one patient who had a drug exanthem from amoxicillin.. Borrelia burgdorferi can be reliably cultured from skin biopsy specimens of secondary EM. Culture preparation aids definitive diagnosis of Lyme disease in patients with only primary EM who often lack constitutional symptoms, have nondiagnostic lesions, or are seronegative.

Topics: Administration, Oral; Adult; Amoxicillin; Antibodies, Bacterial; Azithromycin; Borrelia burgdorferi Group; Erythema Chronicum Migrans; Erythromycin; Female; Heart Diseases; Humans; Male; Middle Aged; Recurrence; Skin; Wisconsin

To compare the safety and efficacy of azithromycin, amoxicillin/probenecid, and doxycycline for the treatment of early Lyme disease, to identify risk factors for treatment failure, and to describe the serologic response in treated patients.. Fifty-five patients with erythema migrans and two patients with flu-like symptoms alone and fourfold changes in antibody titers to Borrelia burgdorferi were randomized to receive (1) oral azithromycin, 500 mg on the first day followed by 250 mg once a day for 4 days; (2) oral amoxicillin 500 mg and probenecid 500 mg, three times a day for each for 10 days; or (3) doxcycline, 100 mg twice a day for 10 days. If symptoms were still present at 10 days, treatment was extended with amoxicillin/probenecid or doxycycline for 10 more days. Evaluations were done at study entry and 10, 30, and 180 days later.. Three of the patients who initially had symptoms suggestive of spread of the spirochete to the nervous system, one from each antibiotic treatment group, subsequently developed neurologic abnormalities, but symptoms in the other 54 patients resolved within 3 to 30 days after study entry. Six of the 19 patients (32%) (95% confidence interval, 13% to 57%) given amoxicillin/probenecid developed a drug eruption, whereas none of the patients given azithromycin or doxycycline had this complication. The presence of dysesthesias at study entry was the only risk factor significantly associated with treatment failure (p less than 0.001). By convalescence, 72% of the patients were seropositive, and 56% still had detectable IgM responses to the spirochete 6 months later.. The three antibiotic regimens tested in this study were generally effective for the treatment of early Lyme disease, but the regimens differ in the frequency of side effects and in ease of administration.

Topics: Adult; Amoxicillin; Antibodies, Bacterial; Azithromycin; Borrelia burgdorferi Group; Doxycycline; Erythema Chronicum Migrans; Erythromycin; Female; Follow-Up Studies; Humans; Immunoglobulin G; Immunoglobulin M; Lyme Disease; Male; Middle Aged; Nervous System Diseases; Pilot Projects; Probenecid; Sensation; Treatment Outcome

Azithromycin, doxycycline and phenoxymethylpenicillin were compared in a prospective, randomized study of 64 patients with typical erythema migrans. Twenty patients were treated with oral azithromycin, 250 mg bd for two days followed by 250 mg od for eight days, 21 patients were given phenoxymethylpenicillin 1 million IU tds for 14 days and 23 patients received doxycycline, 100 mg bd for 14 days. All patients were followed up for 24 months. There were no significant differences between the groups with respect to the persistence of cutaneous lesions after starting treatment; the mean durations were 10.5 days in the penicillin group, 8.8 days in the doxycycline group and 8.6 days in the azithromycin group. There were statistically significant differences in terms of the resolution of associated local and/or systemic symptoms. The response time was shortest in patients treated with azithromycin. Two patients who received phenoxymethylpenicillin and two given doxycycline subsequently developed major manifestations of Lyme borreliosis; these did not occur in patients receiving azithromycin. Although azithromycin has been shown to be effective in the treatment of erythema migrans, further studies will be needed to determine the optimal dosage and duration of therapy.

Topics: Adolescent; Adult; Aged; Azithromycin; Doxycycline; Erythema Chronicum Migrans; Erythromycin; Humans; Male; Middle Aged; Penicillin V; Prospective Studies; Random Allocation

Neonatal tick bites place infants at risk for acquiring infections that have rarely or never been documented in this age group. We describe 2 rare cases of tickborne infection in neonates. The first patient presented with multiple erythema migrans and fever, leading to a diagnosis of early disseminated Lyme disease. The second patient presented with irritability, fever, and worsening anemia due to babesiosis. Both infants had been bitten by arthropods fitting the description of ticks before the onset of symptoms. Our cases demonstrate the clinical course of 2 common tickborne infections occurring at an atypical age, opening the door to new, complex questions for which little guiding data exists. As tickborne infections become more prevalent, we expect other clinicians will be faced with similarly challenging neonatal cases. Providers must use past experience and a keen eye to identify neonates with tickborne infections and sort through their optimal diagnosis and management. In this article, we raise some of the questions we faced and discuss our conclusions.

Topics: Animals; Anti-Bacterial Agents; Antiprotozoal Agents; Atovaquone; Azithromycin; Babesiosis; Ceftriaxone; Erythema Chronicum Migrans; Exanthema; Female; Humans; Infant, Newborn; Parasitemia; Tick Bites

Comparison of clinical efficacy and adverse effects of treatment with azithromycin and amoxicillin in children with solitary erythema migrans (EM).. Consecutive patients younger than 15 years with untreated solitary EM referred to our institution 2002-2003 were included in this unblinded prospective clinical study in which patients were alternatively treated with either azithromycin for 5 days or amoxicillin for 14 days. The efficacy of treatment of acute disease, development of minor and major manifestations of Lyme borreliosis and adverse effects of treatment were surveyed by follow-up visits during the first year after inclusion.. Eighty-four patients received azithromycin and 84 amoxicillin. Pretreatment characteristics in the 2 groups were comparable with the exception that patients in azithromycin group more often reported a tick bite at the site of later EM (69% versus 52%; P = 0.0400), had more often EM on the trunk (50% versus 26%; P = 0.0025) and reported longer duration of symptoms (median 3 versus 2 days; P = 0.0283). The posttreatment period revealed no significant differences between azithromycin and amoxicillin groups including the duration of EM (median 3 days; P = 0.8984) and the appearance of minor (12% versus 21%; P = 0.2146) and major manifestations (2.6% in each group) of Lyme borreliosis. Adverse effects of treatment were observed in 21% of patients treated with azithromycin and in 16% treated with amoxicillin, and the appearance of Jarisch-Herxheimer reaction was recorded in 7% and 15%, respectively (P = 0.1438).. Comparison of azithromycin and amoxicillin for the treatment of children with solitary EM revealed comparable efficacy and adverse effects of treatment.

Topics: Adolescent; Amoxicillin; Anti-Bacterial Agents; Azithromycin; Child; Erythema Chronicum Migrans; Humans; Prospective Studies

Topics: Amoxicillin; Anti-Bacterial Agents; Azithromycin; Cefuroxime; Child; Erythema Chronicum Migrans; Humans; Penicillin V

The recent information on the appearance of erythema migrans despite prophylaxis with 200 mg of doxycycline was the stimulus for a search among our patients for those who developed the skin lesion regardless of receiving antibiotics after a tick bite.. Data were reviewed for adult patients with erythema migrans diagnosed at our institution from 1994 to July 2001, targeting those who received antibiotics after a tick bite.. Seven of 5056 (0.14%) patients, diagnosed with typical erythema migrans, developed the skin lesion despite receiving antibiotics after a tick bite. Antibiotics were prescribed by general physicians: in four cases as prophylaxis of Lyme borreliosis within one day after tick detachment and in three cases because of development of acute respiratory tract infection two, five, and eight days after the bite, respectively. The dosages were as follows: azithromycin in a total dose of 3 g in three patients and 1.5 g in the fourth patient, amoxicillin-clavulanic acid 625 mg t.i.d. for ten days in the fifth patient, amoxycillin 500 mg t.i.d. for seven days followed by azithromycin 250 mg o.d. for eight days in the sixth, and amoxycillin 500 mg t.i.d. for eight days in the seventh. The patients (five females and two males, aged 18-61 years) were referred to our Department on average six (1-19) days after the appearance of skin lesions. They had typical solitary (five patients) or multiple (two patients) erythema migrans with the characteristics usually seen in European patients, except for a rather long incubation period (median value 28 days, range 10-40 days). All laboratory tests, including the examination of cerebrospinal fluid in three patients with the disseminated form of the illness, were within normal range. Borrelial antibodies were demonstrated in only one patient. A skin biopsy specimen obtained from the site of the erythema migrans was culture positive for Borrelia in 2/4 patients.. Our study did not enable us to assess the frequency of antimicrobial prophylaxis failure or the efficacy of individual antibiotics for the prevention of Lyme borreliosis. However, the seven patients presented demonstrate that antibiotic prophylaxis for Lyme borreliosis after a tick bite, at least in Europe, is not entirely effective.

Topics: Adolescent; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Animals; Anti-Bacterial Agents; Azithromycin; Bites and Stings; Dose-Response Relationship, Drug; Drug Administration Schedule; Erythema Chronicum Migrans; Female; Humans; Ixodes; Lyme Disease; Male; Middle Aged; Premedication; Retrospective Studies; Slovenia; Treatment Failure

Prolongation of the corrected Q-T (Q-Tc) interval is associated with a risk of severe and even life-threatening arrythmias. It may occur as an adverse effect of various pharmacological agents including macrolides. We opted to study the influence of the azalide antibiotic azithromycin on the duration of Q-Tc interval as data on this subject are limited.. A prospective study was performed on 47 patients, 31 females and 16 males, aged 19-77 (median 52) years, treated with azithromycin (total dosage 3 g, divided over 5 days) for typical solitary erythema migrans. The patients were previously healthy and were not receiving any other medication. In all of them ECGs were performed before as well as 7 and 14 days after initiation of the azithromycin therapy. Thus, a total of 141 ECG tracings were analyzed. Q-T intervals were measured manually in a blinded manner and corrected for heart rate according to Bazzet's formula: Q-Tc = measured Q-T (ms)/square root of R-R (s).. Comparison of the Q-Tc intervals before, 7 days, and 14 days after the initiation of azithromycin treatment revealed a mild, but not significant prolongation (median values 406, 412.5 and 419 ms with ranges of 339-488, 352-510, and 346-505 ms, respectively). Q-Tc intervals exceeding the upper normal value of 440 ms were found in the same proportion of patients prior to as after institution of treatment. None of the ECG tracings showed significant arrhythmias.. In previously healthy persons, a modest statistically insignificant prolongation of the Q-Tc interval without clinical consequences was observed after completion of a course of 3 g of azithromycin administered over a period of 5 days for solitary erythema migrans.

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Dose-Response Relationship, Drug; Drug Administration Schedule; Electrocardiography; Erythema Chronicum Migrans; Female; Humans; Long QT Syndrome; Male; Middle Aged; Prospective Studies; Risk