"Shorter courses of treatment are safer, less expensive, and may be less likely to promote emergence of resistant bacteria that can endanger the entire community," said Gary P. Wormser, MD, of New York Medical College in Valhalla, N.Y., lead author of the study.
The randomized trial assigned patients to three groups. One got either a single intravenous dose of an antibiotic (ceftriaxone) followed by 10 days of antibiotic pills (doxycycline twice daily) and then 10 more days of dummy pills (placebo twice daily). Another received intravenous sugar water, as a placebo, followed by 10 days of doxycycline pills and then 10 days of placebo pills. The third received intravenous placebo fluid followed by 20 days of doxycycline pills.
"Most patients responded similarly to either the 10-day or 20-day cycle," said Wormser. "The study suggests that people with early Lyme disease and no heart, joint or neurologic abnormalities, such as meningitis, can usually be treated successfully with 10 days of antibiotic therapy."
Approximately two-thirds of patients in each group had a complete response at 20 days, and more than 80 percent of all patients had a complete response at 30 months.
"Similar results were found in 49 patients with erythema migrans (the hallmark red rash caused by Lyme disease) who received 10 or 20 days of tetracycline, a drug related to doxycycline, as reported in Annals of Internal Medicine in 1980," said Allen C. Steere, MD, one of the discoverers of Lyme disease in 1975 and a well-known researcher on the disease since. "However, the study published in Annals today demonstrated this fairly conclusively in a larger number of patients."
In an accompanying editorial, Steere says, "In brief, Lyme disease can usually be treated successfully with oral doxycycline or amoxicillin, except for patients with objective neurologic abnormalities. Ten days of doxycycline therapy is usually enough for patients with the erythema migrans rash. With such treatment, most patients have satisfactory outcomes."
ACP (Internal Medicine. Doctors for Adults ®), publisher of Annals of Internal Medicine, is the second-largest physician group in the United States. Membership includes internists, related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illnesses in adults.
NOTES TO EDITOR:
Copies of the embargoed article, "Duration of Antibiotic Therapy for Early Lyme Disease," and the editorial, "Duration of Antibiotic Therapy for Lyme Disease," are available by calling 800-523-1546, ext. 2656 or 215-351-2656.
Dr. Wormser is chief of infectious diseases at New York Medical College and Westchester Medical Center. For an interview, call Donna Moriarty, New York Medical College Office of Public Relations, 914-594-4536.
Clay Heydorn, a patient with Lyme disease who participated in the Wormser study and was successfully treated with a 10-day course of antibiotics, is available for interview. Call Donna Moriarty, New York Medical College Office of Public Relations, 914-594-4536.
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Journal
Annals of Internal Medicine