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TREATMENT OF ACUTE DISSEMINATED LYME DISEASE.

Both parenteral and oral antibiotics have been used successfully to treat acute Lyme disease. This randomized trial compared a two-week course of intramuscular or intravenous ceftriaxone with a three-week course of oral doxycycline in 140 patients with acute disseminated Lyme disease. All patients were at least eight years old and had at least one of the following: more than one erythema migrans lesion, heart block, neurologic abnormalities such as seventh-nerve palsy (but not meningitis or encephalitis), and large joint arthritis.

About 15 percent of each group could not be assessed because of inadequate follow-up or early discontinuation of the drug. Of the remainder, only one patient in each group had evidence of Lyme disease at a nine-month follow-up visit. Gastrointestinal side effects were significantly more common with ceftriaxone than with doxycycline (41 vs. 25 percent).

Comment: Doxycycline and ceftriaxone appear equally effective for acute disseminated Lyme disease. Doxycycline is less expensive and better tolerated, and therefore should serve as first-line therapy.

— AS Brett

Published in Journal Watch General Medicine August 15, 1997

Citation(s):

Dattwyler RJ et al. Ceftriaxone compared with doxycycline for the treatment of acute disseminated Lyme disease. N Engl J Med 1997 Jul 31 337 289-294.

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