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Comparison of Cefuroxime Axetil and Doxycycline in the Treatment of Early Lyme Disease

Robert B. Nadelman, MD; Steven W. Luger, MD; Elliot Frank, MD; Michael Wisniewski, PhD; Jeffrey J. Collins, PhD; and Gary P. Wormser, MD
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Presented in part at the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy 21-24 October 1990, Atlanta, Georgia, and at the 17th International Congress of Chemotherapy 23-28 June 1991, Berlin, Germany.

Affiliations: New York Medical College, Westchester County Medical Center, Valhalla, New York; Old Lyme Family Practice Group, Old Lyme, Connecticut; Jersey Shore Medical Center, Neptune, New Jersey; and Glaxo Inc., Research Triangle Park, North Carolina.

Grant Support: Glaxo Inc., Research Triangle Park, NC 27709.

Requests for Reprints: Robert B. Nadelman, MD, Westchester County Medical Center, Division of Infectious Disease, Macy Pavilion 209 Southeast, Valhalla, NY 10595.

Current Author Addresses: Drs. Nadelman and Wormser: Westchester County Medical Center, Division of Infectious Diseases, Macy Pavilion 209 Southeast, Valhalla, NY 10595.

Dr. Luger: Old Lyme Family Practice, PC, 8 Davis Road West; Old Lyme, CT 06371.

Dr. Frank: Department of Medicine, Jersey Shore Medical Center, 1945 Corlies Avenue, Neptune, NJ 07753.

Drs. Wisniewski and Collins: Glaxo Inc. Research Institute, 5 Moore Drive, Research Triangle Park, NC 27709.

©1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;117(4):273-280. doi:10.7326/0003-4819-117-4-273
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Objective: To compare the efficacy of cefuroxime axetil and doxycycline in the treatment of patients with Lyme disease associated with erythema migrans.

Design: Randomized, multicenter, investigatorblindedclinical trial with clinical evaluations during treatment (8 to 12 days) and at 1 to 5 days and 1, 3, 6, 9, and 12 months post-treatment.

Setting: Three university referral centers and one private practice.

Patients: A total of 123 patients with physician-documentederythema migrans.

Intervention: Patients were treated orally for 20 days with either cefuroxime axetil, 500 mg twice daily (63 patients), or doxycycline, 100 mg three times daily (60 patients).

Measurements: Resolution of erythema migrans and of signs and symptoms related to early Lyme disease as well as prevention of late Lyme disease.

Results: A satisfactory clinical outcome (success or improvement) was achieved in 51 of 55 (93%) evaluable patients treated with cefuroxime axetil and in 45 of 51 (88%) patients treated with doxycycline (difference, 5%; 95% Cl, - 5% to 14%). The only complication at 1 month post-treatment was Lyme arthritis in one patient who received doxycycline. Of the patients with satisfactory outcomes at 1 month post-treatment who were evaluable at 1 year post-treatment, a satisfactory outcome was achieved in 43 of 48 (90%) and in 35 of 38 (92%) patients treated with cefuroxime axetil and doxycycline, respectively (difference, - 2%; Cl, - 12% to 7%). Lyme arthritis did not develop in any patient after 1 month post-treatment, whereas peripheral neuropathy was suspected in one patient treated with cefuroxime axetil. Thirty percent of patients treated with cefuroxime axetil and 32% of those treated with doxycycline had one or more drug-related adverse events. Doxycycline was associated with more photosensitivity reactions (15% compared with 0%; P = 0.001) and cefuroxime axetil with more diarrhea (21% compared with 7%; P = 0.035) and Jarisch-Herxheimer reactions (29% compared with 8%; P = 0.005).

Conclusions: Cefuroxime axetil is well tolerated and appears to be equally as effective as doxycycline in the treating of early Lyme disease and in preventing the subsequent development of late Lyme disease.





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