This article is more than 5 years old. Information may no longer be current.
Antibiotics effective in patients with erythema migrans, malignancies
Patients with erythema migrans and underlying hematological malignancies were more likely to have signs of disseminated Lyme borreliosis and require retreatment with antibiotics, according to recent findings.
Both patients with and without malignancies, however, had excellent treatment outcomes with antibiotics, researchers wrote in Clinical Infectious Diseases.
In the study, researchers evaluated 53 adult patients diagnosed with erythema migrans (EM) and underlying hematologic malignancies (HM) treated at the Lyme borreliosis outpatient clinic at the University Medical Center in Ljubljana, Slovenia, between 1992 and 2013.
The researchers enrolled two gender- and antibiotic treatment-matched immunocompetent patients with EM (n = 106) for each patient with HM and EM. Patients and controls, aged 17 to 75 years, were clinically examined before initiation of antibiotic therapy, and subsequently at 2 weeks, 2 months, 6 months and 1 year after the baseline visit.
At the initial visit, patients with HM began treatment with one of the following regimens:
- doxycycline 100 mg twice daily for 15 days (n = 14);
- amoxicillin 500 mg three times daily for 15 days (n = 13);
- cefuroxime axetil 500 mg twice daily for 15 days (n = 12);
- azithromycin 500 mg twice daily on the first day, then 500 mg once daily for 4 days (n = 10); or
- IV ceftriaxone 2 g once daily for 14 days (n = 4).
The researchers found that after initiating treatment, the duration of EM was comparable in patients with HM (median, 7 days) vs. controls (median, 10 days; P = .24). Among four patients with signs of disseminated borrelial infection at baseline who were treated with ceftriaxone, the course and outcome of Lyme disease was favorable.
Three (5.7%; 95% CI, 1.2-15.7) other patients with HM, however, required additional antibiotic therapy, while none in the immunocompetent group needed additional therapy (95% CI for the difference, –2 to 13). This additional therapy was needed in one patient due to the onset of subjective symptoms, in the second patient due to persistent EM, and in the third patient because of multiple EM.
Similarly, patients with HM had a more complicated course of EM vs. immunocompetent patients. For example, disseminated early Lyme disease or treatment failure was detected in seven of 53 (13.2%; 95% CI, 5.5-25.3) patients with HM vs. none of 106 immunocompetent patients (95% CI, 0-3.4%; 95% CI for the difference, 2.7-23.7).
The researchers said despite the differences in the course of EM, treatment outcomes were excellent in both groups.
“Our study showed that antibiotic treatment approach as used in immunocompetent patients with EM is effective also in patients with underlying HM,” the researchers wrote. “The results apply to European regions with similar ratios of Borrelia genospecies causing EM as in Slovenia, but may not entirely pertain to North America where [Lyme borreliosis] is caused by B. burgdorferi.”
Disclosure: One of the researchers is a consultant to Baxter on Lyme vaccine and a member of the steering committee of the European Society of Clinical Microbiology and Infectious Diseases Study Group on Lyme Borreliosis.