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Shorter course of doxycycline effective treatment for erythema migrans
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Compared with a 15-day course of oral doxycycline, a 10-day course was noninferior in European patients with erythema migrans.
“The efficacy of shorter, 10-day treatment with doxycycline has been estimated in the United States, but not Europe,” researchers from Ljubljana, Slovenia, wrote. “The clinical course of erythema migrans in Europe differs somewhat from that in the United States, and there has been no direct comparison between the two continents on the efficacy of individual antibiotics for this condition.”
The researchers conducted a noninferiority trial to evaluate the efficacies of a 10-day doxycycline regimen and a 15-day doxycycline regimen. They compared nonspecific symptoms between patients with erythema migrans and control participants without Lyme borreliosis. They assessed the efficacy of treatment at 14 days, 2, 6 and 12 months.
The study included 117 patients who received a 15-day course of doxycycline treatment and 108 patients who received a 10-day course of doxycycline treatment. After 12 months, a complete response was seen in 93.4% of the patients in the 15-day group and 91.9% of patients in the 10-day group.
Most patients in both groups had a complete response from 2 months onward. Nonspecific symptoms were similar among patients in the control group and in the treatment groups at 6 months.
“In comparison with lengthy treatment, short courses of antibiotics are safer, cheaper and more convenient and have fewer detrimental ecologic effects,” the researchers wrote. “The challenge is to achieve a favorable treatment result with the shortest possible course of antibiotics.”
References:
Stupica D. Clin Infect Dis. 2012;55:343-350.
Disclosures:
The researchers report no relevant financial disclosures.
Perspective
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Eugene Shapiro, MD
This study found no differences in outcomes of patients with Lyme disease (erythema migrans) in Slovenia who were treated with doxycycline for either 10 days or 15 days. Moreover, the prevalence of nonspecific symptoms such as fatigue and arthralgia at various follow-up times were not significantly different either between the two groups or compared with controls subjects without Lyme disease. The effectiveness of 10 days of doxycycline to treat early localized Lyme disease has already been demonstrated in the United States. However, Borrelia burgdorferi sensu stricto, the only cause of Lyme disease in the United States, may be more likely to disseminate earlier to other tissues through the bloodstream than are B. afzelii, the main cause of Lyme disease in this study, or other European species of Borrelia that cause Lyme disease. Although 10 days of treatment with doxycycline may be effective to treat early localized Lyme disease for many patients in the United States, it may be important to identify and to exclude patients with risk factors for early dissemination (eg, duration of illness). Additional data are needed before recommendation for treatment for only 10 days for all patients with early Lyme disease is made routine.
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