Comparison of azithromycin and amoxicillin for treatment of adult patients with solitary erythema migrans
Abstract number: 902_p530
To evaluate the effectiveness and side effects of azithromycin and amoxicillin for treatment of adult patients with solitary erythema migrans.
Consecutive adult patients with typical erythema migrans were enrolled in a prospective study on early Lyme borreliosis at the Department of Infectious Diseases in Ljubljana during 1997. Patients receiving antibiotics at their first visit, having clinical evidence of disseminated Borrelia burgdorferi s.l. infection, and/or being pregnant were excluded. They were randomised to receive either azithromycin 500 mg b.i.d. for the first day, followed by 500 mg once a day for the following 4 days (AZT) or amoxicillin 1000 mg t.i.d. for the first 5 days, followed by 500 mg t.i.d. for the following 10 days (AMO). Basic epidemiological data were obtained by means of questionnaires. Serum IgM and IgG antibody titre against B. burgdorferi s.l. were determined by IFA without absorbtion. Titres equal and/or greater than 1:256 were interpreted as positive. In all patients skin biopsy had been accomplished prior to the institution of antibiotic treatment and specimen cultured in MKP medium.
A total of 133 patients, 77 (57.9%) females and 56 (42.1%) males, aged 1683 (median 49) years were included in this study. Sixty-five patients were evaluated in AZT group and 68 patients in AMO group. No differences in epidemiological and pretreatment characteristics were present comparing the two groups. Median duration of skin lesions after the institution of treatment was 7 (160) days in the AZT group and 7 (2180) days in the AMO group (P = 0.325). During the follow-up of 12 months none of the patients developed major late manifestations of Lyme borreliosis but in six patients severe minor manifestations appeared: in two (3.1%) from AZT group and in four (5.9%) included in AMO group. Isolation rates of B. burgdorferi s.l. from skin before treatment (25/65 vs. 33/68; P = 0.319) as well as 23 months after therapy (0/25 vs. 0/33) were comparable for the two groups. Three (4.6%) AZT group patients and one (1.5%) patient from AMO group reported mild gastrointestinal discomfort (P = 0.358).
Treatment of adult patients with solitary erythema migrans with two different antibiotics exhibited equal effectiveness and comparable side effects. The outcome of borrelial infection after one year was favourable in both treatment groups."
|Session name:||XXIst ISTH Congress|
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