zithromax and Lyme-Disease

Lyme disease (LD) is a heavy public health burden. The most common manifestations of LD include erythema migrans (EM), Lyme neuroborreliosis (LNB), and Lyme arthritis (LA). The efficacy and safety of antibiotics for treating LD is still controversial. Thus, we performed a network meta-analysis (NMA) to obtain more data and tried to solve this problem. We searched studies in the databases of Embase and PubMed from the date of their establishments until 22 April 2021. Odds ratios (ORs) were used to assess dichotomous outcomes. A total of 31 randomized controlled trials (RCTs) involving 2,748 patients and 11 antibiotics were included. Oral amoxicillin (1.5 g/day), oral azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were effective for treating LD (range of ORs, 1.02 to 1,610.43). Cefuroxime and penicillin were safe for treating LD (range of ORs, 0.027 to 0.98). Amoxicillin was effective for treating EM (range of ORs, 1.18 to 25.66). Based on the results, we thought oral amoxicillin (1.5 g/day), oral azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were effective for treating LD. Cefuroxime and penicillin were safe for treating LD. Amoxicillin was effective for treating EM. We did not observe evidence proving the advantage of doxycycline in efficacy and safety for treating LD, LA, LNB, and EM of children or adults. We did not have sufficient data to prove the significant difference of efficacy for treating LA and LNB in adults and LD in children, the significant difference of safety of oral drugs for treating LD, and the significant difference of safety of drugs for treating EM.

Topics: Administration, Oral; Adult; Amoxicillin; Anti-Bacterial Agents; Azithromycin; Borrelia burgdorferi; Borrelia burgdorferi Group; Cefotaxime; Ceftriaxone; Child; Doxycycline; Humans; Injections; Lyme Disease; Network Meta-Analysis; Penicillins

SENLAT syndrome, also known as TIBOLA/DEBONEL, is an emerging disease in France. The major symptoms are necrotic eschar on the scalp associated with painful cervical lymphadenopathy. It occurs mainly in women and children during the cold seasons after a bite by a Dermacentor tick, responsible for transmitting Rickettsia slovaca or Rickettsia raoultii. Cutaneous swabs are safe, easy and reliable tools that should be used routinely by physicians to confirm diagnosis. In this particular disease, they should be preferred to serology, which is less sensitive. Doxycycline is the antibiotic of choice for this syndrome.

Topics: Animals; Anti-Bacterial Agents; Arachnid Vectors; Azithromycin; Bartonella henselae; Bartonella Infections; Dermacentor; Diagnosis, Differential; Doxycycline; Europe; France; Humans; Josamycin; Lyme Disease; Lymphatic Diseases; Neck; Necrosis; Rickettsia; Rickettsia Infections; Scalp Dermatoses; Species Specificity; Symptom Assessment; Syndrome; Tick Bites; Tick-Borne Diseases; Zoonoses

Topics: Adult; Amoxicillin; Azithromycin; Ceftriaxone; Cefuroxime; Child; Child, Preschool; Clarithromycin; Contraindications; Doxycycline; Female; Humans; Infectious Disease Transmission, Vertical; Lyme Disease; Male; Pregnancy; Pregnancy Complications, Infectious

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

Lyme borreliosis develops in 1-5% of individuals bitten by ticks, but with a diagnostic gap affecting up to 30% of patients, a broadly applicable pharmacological prevention strategy is needed. Topical azithromycin effectively eradicated Borrelia burgdorferi sensu lato from the skin in preclinical studies. We assessed its efficacy in human beings.. In this randomised, double-blind, placebo-controlled, multicentre trial done in 28 study sites in Germany and Austria, adults were equally assigned to receive topical 10% azithromycin or placebo twice daily for 3 consecutive days, within 72 h of a tick bite being confirmed. Randomisation numbers, which were stratified by study site, were accessed in study centres via an interactive voice-response system, by pharmacists not involved in the study. The primary outcome was the number of treatment failures, defined as erythema migrans, seroconversion, or both, in participants who were seronegative at baseline, had no further tick bites during the study, and had serology results available at 8 weeks (intention-to-treat [ITT] population). This study is registered with EudraCT, number 2011-000117-39.. Between July 7, 2011, and Dec 3, 2012, 1371 participants were randomly assigned to treatment, of whom 995 were included in the ITT population. The trial was stopped early because an improvement in the primary endpoint in the group receiving azithromycin was not reached. At 8 weeks, 11 (2%) of 505 in the azithromycin group and 11 (2%) of 490 in the placebo group had treatment failure (odds ratio 0·97, 95% CI 0·42-2·26, p=0·47). Topical azithromycin was well tolerated. Similar numbers of patients had adverse events in the two groups (175 [26%] of 505 vs 177 [26%] of 490, p=0·87), and most adverse events were mild.. Topical azithromycin was well tolerated and had a good safety profile. Inclusion of asymptomatic seroconversion into the primary efficacy analysis led to no prevention effect with topical azithromycin. Adequately powered studies assessing only erythema migrans should be considered. A subgroup analysis in this study suggested that topical azithromycin reduces erythema migrans after bites of infected ticks.. Ixodes AG.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Borrelia burgdorferi; Double-Blind Method; Female; Germany; Humans; Lyme Disease; Male; Middle Aged; Ticks; Treatment Failure

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

Topics: Administration, Cutaneous; Animals; Azithromycin; Biological Availability; Chemistry, Pharmaceutical; Lyme Disease; Nanoparticles; Silicon Dioxide; Skin; Solubility; Swine; X-Ray Diffraction

A 67-year-old woman presented with 5 days of myalgias and fevers on completion of a 21-day course of amoxicillin for Lyme disease (

Topics: Aged; Animals; Anti-Bacterial Agents; Atovaquone; Azithromycin; Babesia microti; Babesiosis; Coinfection; Female; Humans; Ixodes; Lyme Disease

Topics: Azithromycin; Borrelia burgdorferi Group; Humans; Lyme Disease

As an alternative to oral prophylaxis for the prevention of tick transmission of Borrelia burgdorferi, we tested antibiotic cream prophylactic formulations in a murine model of spirochete infection. A 4% preparation of doxycycline cream afforded no protection, but a single application of 4% azithromycin cream was 100% protective when applied directly to the tick bite site at the time of tick removal. Indeed, the azithromycin cream was 100% effective when applied at up to 3 days after tick removal and protected 74% of mice exposed to tick bite when applied at up to 2 weeks after tick removal. Azithromycin cream was also protective when applied at a site distal to the tick bite site, suggesting that it was having a systemic effect in addition to a local transdermal effect. Mice that were protected from tick-transmitted infection did not seroconvert and did not infect larval ticks on xenodiagnosis. Azithromycin cream formulations appear to hold promise for Lyme disease prophylaxis.

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Borrelia burgdorferi; Doxycycline; Female; Lyme Disease; Mice; Ticks

We present a 46-year-old male patient with complete atrio-ventricular block. A inflammatory etiology was suspected and finally lyme carditis was diagnosed. The conduction abnormalities disappeared with antibiotic treatment and a pacemaker implantation was not needed. Further follow-up of two years was uneventful.

Topics: Anti-Bacterial Agents; Atrioventricular Block; Azithromycin; Ceftriaxone; Doxycycline; Drug Administration Schedule; Drug Therapy, Combination; Electrocardiography; Humans; Lyme Disease; Male; Middle Aged; Myocarditis; Pacemaker, Artificial

A study published in 1998 linking MMR vaccine and autism was recently retracted by the Lancet because the data were falsified. The impressive reduction of invasive pneumococcal diseases with the 7-valent pneumococcal conjugate vaccine is due to a more than 90% reduction in rates of infections due to vaccinal serotypes at the expense of a slight increase in non-vaccinal serotypes. Genes encoding resistance factors to several antibiotic classes were detected in 30000-year-old samples. New Delhi metallo-beta-lactamase 1 was frequently detected in street water in New Dehli. Azithromycin decreased COPD exacerbations in a select group of patients with COPD at the cost of more frequent small decrements in hearing. Cranberry juice did not prevent recurrent urinary tract infections. Some patients with persistent symptoms after Lyme disease had higher levels of anti-Borrelia antibodies than cured patients.

Topics: Anti-Bacterial Agents; Azithromycin; beta-Lactamase Inhibitors; beta-Lactamases; Communicable Disease Control; Communicable Diseases; Drug Resistance, Microbial; Epidemiology; Humans; Lyme Disease; Measles; Measles-Mumps-Rubella Vaccine; Pneumococcal Infections; Pneumococcal Vaccines; Pulmonary Disease, Chronic Obstructive; Serotyping; Vaccines, Conjugate

Topics: Animals; Anti-Bacterial Agents; Azithromycin; Bites and Stings; Gels; Humans; Ixodes; Lyme Disease

Systemic antibiotic treatment of Lyme borreliosis is effective during the early stages of the infection, while chronic manifestations of the disease may remain refractory and difficult to treat. This study was carried out in order to evaluate the potential of topically applied azithromycin to eliminate the spirochaetal organisms in the skin of the freshly bitten host and thereby prevent Lyme borreliosis.. Laboratory mice were challenged with Borrelia burgdorferi sensu stricto by needle inoculation or via infected ticks as vectors. Then, an azithromycin-containing formulation was applied once daily to the sites of exposure for three consecutive days. In the case of needle inoculation, a 5% azithromycin formulation was applied starting 1 h, 3 days and 5 days after infection. In the case of tick exposure, 4%, 10% and 20% azithromycin formulations were applied, starting directly after the detachment of the engorged ticks. Subsequently, the infection status of the mice was determined.. Concentrations of azithromycin in murine skin were >3800-fold higher than the published minimal inhibitory concentration for B. burgdorferi as soon as 3 h after the first application. After needle inoculation, spirochaetes were not detectable in all infected mice after treatment, if the first application started 1 h or even after 3 days post-infection. Furthermore, no borrelial organisms were detected after topical treatment when ticks were used for spirochaete inoculation.. Our data indicate that topical treatment with a formulation containing azithromycin is a promising approach to prevent Lyme borreliosis shortly after a tick bite.

Topics: Administration, Topical; Animals; Anti-Bacterial Agents; Antibiotic Prophylaxis; Azithromycin; Borrelia burgdorferi; Female; Lyme Disease; Mice; Mice, Inbred C3H; Skin; Ticks; Treatment Outcome

Topics: Aged; Anti-Bacterial Agents; Azithromycin; Humans; Lyme Disease; Lyme Neuroborreliosis; Male

The purpose of this study was to begin to characterise the pharmacodynamic parameters of single-dose doxycycline for the prevention of Lyme disease following a tick bite. Based on limited data from published human and murine studies, it was found that there is a direct correlation between efficacy rate and the area under the time-concentration of free antibiotic curve divided by the minimum inhibitory concentration (fAUC/MIC) (R(2)=0.74, using Pearson correlation), but not the maximum concentration of free drug in serum divided by the MIC (fC(max)/MIC) or the time that the free drug concentration remains above the MIC (fT>MIC). To determine the possible implications of these findings for other antimicrobials, it was assumed that the pharmacodynamic properties of doxycycline would be pertinent to azithromycin, an antibiotic whose activity is known to correlate with AUC/MIC. By making such an extrapolation and using pharmacokinetic modelling with conservative assumptions on MIC values against Borrelia burgdorferi, it is hypothesised that a single 500 mg dose of azithromycin in humans should have comparable efficacy to doxycycline for the prevention of Lyme disease. Additional experimental studies are needed to clarify more precisely the pharmacodynamic properties of doxycycline and to validate the accuracy of this hypothesis.

Topics: Animals; Anti-Bacterial Agents; Area Under Curve; Azithromycin; Borrelia burgdorferi; Chemoprevention; Doxycycline; Humans; Lyme Disease; Mice; Microbial Sensitivity Tests; Serum; Time Factors

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

Borrelia burgdorferi infection in beagle dogs was studied quantitatively with skin punch biopsy samples and blood samples collected at 4- and 2-week intervals, respectively, over a 500-day period. Thereafter, 25 tissue samples of each dog were collected for further analysis. Starting at day 120 after tick challenge, 12 dogs were treated with antibiotics (azithromycin, ceftriaxone, or doxycycline) for 30 consecutive days. Four dogs received no antibiotic therapy. Quantification of B. burgdorferi DNA was done with an ABI Prism 7700 Sequence Detection System with oligonucleotide primers and a fluorescence-labeled probe designed to specifically amplify a fragment of the ospA gene of B. burgdorferi strain N40. All 16 dogs became infected with B. burgdorferi after tick challenge. In skin biopsy samples, spirochete numbers peaked at day 60 postinfection (<1.5 x 10(6) organisms per 100 microgram of extracted DNA), at the same time when clinical signs of arthritis developed in 11 of 16 dogs, and decreased to almost undetectable levels during the following 6 months. The number of B. burgdorferi organisms detected in skin biopsy samples was inversely correlated with the antibody levels measured by enzyme-linked immunosorbent assay. Antibiotic treatment reduced the amount of detectable spirochete DNA in skin tissue by a factor of 1,000 or more. At the end of the experiment, B. burgdorferi DNA was detectable at low levels (10(2) to 10(4) organisms per 100 microgram of extracted DNA) in multiple tissue samples regardless of treatment. However, more tissue samples of untreated dogs than of antibiotic-treated dogs were positive, and tissue samples of untreated dogs also were positive by culture. Only 1.6% of 576 blood samples of all dogs were positive for B. burgdorferi by PCR.

Topics: Animals; Antibodies, Bacterial; Azithromycin; Biopsy; Borrelia burgdorferi Group; Ceftriaxone; Chronic Disease; DNA, Bacterial; Dog Diseases; Dogs; Doxycycline; Lyme Disease; Microbiological Techniques; Polymerase Chain Reaction; Skin; Tissue Distribution

A 39-year-old HIV positive patient developed myalgia, headache and cough 4 weeks after a tick bite. His temperature was 37.4 degrees C and a circular pale erythema was noted over the left lower leg.. C-reactive protein was raised to 120 mg/l, white blood cell count was 5860/microliter, CD4-lymphocyte count 250/microliter. The chest radiogram showed pneumonitic infiltration in the left lower lobe. There were IgM antibodies against Borrelia burgdorferi.. Left lower lobe pneumonia and chronic erythema migrans were diagnosed and he was given oral azithromycin (500 mg on the first day and 250 mg for 4 days). The pneumonia cleared up, but 2 weeks later he developed symptoms of meningitis (496 cells per microliter, 87% lymphocytes, positive Borrelia burgdorferi antibody titer), which quickly and lastingly responded to ceftriaxon (2 g daily by brief infusion for 14 days).. This immune-compromised HIV-infected patient developed disseminated borreliosis with CNS involvement 2 weeks after the occurrence of chronic erythema migrans. The initial treatment of the latter with azithromycin was unable to prevent the meningitis. It is unlikely that there was a causal connection between the borreliosis and the pneumonia.

Topics: Adult; Animals; Anti-Bacterial Agents; Antibodies, Bacterial; Azithromycin; Borrelia burgdorferi Group; Ceftriaxone; Cephalosporins; HIV Seropositivity; Humans; Immunocompromised Host; Immunoglobulin M; Insect Bites and Stings; Lyme Disease; Male; Meningitis, Bacterial; Pneumonia; Ticks

Topics: Adaptation, Psychological; Adult; Anti-Infective Agents; Azithromycin; Cefixime; Cefotaxime; Ceftriaxone; Drug Administration Schedule; Drug Therapy, Combination; Finland; History, 20th Century; Humans; Lyme Disease; Male

Topics: Azithromycin; Drug Administration Schedule; Erythromycin; Humans; Lyme Disease

The in-vitro and in-vivo susceptibility of Borrelia burgdorferito tetracycline, erythromycin and azithromycin was investigated. A macrodilution broth technique was used to determine MBCs. B. burgdorferi was most susceptible to azithromycin (MBC 0.04 mg/l) followed by erythromycin (MBC 0.16 mg/l) and tetracycline (MBC 1.6 mg/l). Syrian hamsters were used to determine ED50S for the three antimicrobials. Azithromycin was most effective in the elimination of spirochaetes from experimentally infected hamsters with an ED50 of 3.71 (+/- 1.9) mg/kg followed by tetracycline (ED50 15.6 (+/- 4.58) mg/kg). Erythromycin possessed low activity, having an ED50 of 122.2 (+/- 51.9) mg/kg. Tissue concentrations of azithromycin exceeding the MBC were present 24 h after the final treatment.

Topics: Animals; Azithromycin; Borrelia burgdorferi Group; Cricetinae; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Erythromycin; Lyme Disease; Mesocricetus; Tetracycline; Tissue Distribution

The in vitro and in vivo activity of the new macrolides azithromycin, clarithromycin and roxythromycin was compared with that of erythromycin against Borrelia burgdorferi. In in vitro tests using ten clinical isolates all macrolides were highly active against Borrelia burgdorferi (MIC90 0.015-0.06 micrograms/ml). Azithromycin was more potent than the other macrolides in experimental animal infection, eradicating the organism in all animals tested at a dosage of 8 mg/kg.

Topics: 4-Quinolones; Animals; Anti-Infective Agents; Azithromycin; Borrelia; Clarithromycin; Erythromycin; Fluoroquinolones; Gerbillinae; Leucomycins; Lyme Disease; Microbial Sensitivity Tests; Quinolones; Species Specificity