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Treating Early Lyme Disease: 10 Days Is Enough

Extended treatment courses did not benefit adults with uncomplicated disease.

The duration of antibiotic therapy for early Lyme disease has been increasing in clinical practice. In this double-blind trial, researchers randomized 180 patients (minimum age, 16) with annular skin lesions (erythema migrans) of 5 cm in diameter to 1 of 3 treatments: a single 2-g dose of intravenous ceftriaxone, then 10 days of oral doxycycline (100 mg twice daily); 10-day doxycycline alone; or 20-day doxycycline alone.

At 20 days and at 3, 12, and 30 months, the 3 groups did not differ significantly from each other in rates of complete response, partial response, and treatment failure. Rates of complete response at 30 months (i.e., no recurrent erythema migrans, no signs or symptoms of Lyme disease) in the 3 groups ranged from 83% to 85% in the intent-to-treat analysis and from 84% to 90% in adherent patients. Only 1 subject (in the 10-day doxycycline group) failed treatment: This patient developed meningeal signs and cerebrospinal fluid pleocytosis, and recovered with a 2-week course of ceftriaxone therapy. The ceftriaxone-doxycycline group had significantly more adverse events than the other groups did.

Comment: There is no evidence that longer antibiotic courses help patients with early, uncomplicated Lyme disease. However, in an editorial, a recognized Lyme-disease expert reminds readers that patients with objective neurologic findings such as meningitis require extended treatment with IV antibiotics such as ceftriaxone. He also notes that extended antibiotic courses do not help patients who develop musculoskeletal symptoms, fatigue, and cognitive difficulties after receiving standard courses.

— Richard Saitz, MD, MPH, FACP

Published in Journal Watch General Medicine May 20, 2003

Citation(s):

Wormser GP et al. Duration of antibiotic therapy for early Lyme disease: A randomized, double-blind, placebo-controlled trial. Ann Intern Med 2003 May 6; 138:697-704.

• Original article (Subscription may be required)
• Medline abstract (Free)

Steere AC. Duration of antibiotic therapy for Lyme disease. Ann Intern Med 2003 May 6; 138:761-2.

• Original article (Subscription may be required)
• Medline abstract (Free)