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Duration of Antibiotic Therapy for Lyme Disease
Erythema migrans, an expanding annular skin lesion, was described in Europe in the early 20th century (1). In the 1950s, before the cause of the illness was known, European physicians noted that erythema migrans could be treated successfully with penicillin (2). After the description of Lyme arthritis in the United States in 1976, it became apparent that erythema migrans was the initial manifestation of a complex, multisystem illness. It was then shown that oral penicillin G given for 10 days shortened the duration of erythema migrans and often prevented or attenuated subsequent arthritis (3).
In 1980 and 1981, 108 patients with erythema migrans were randomly assigned to receive phenoxymethyl penicillin, erythromycin, or tetracycline for 10 days (4). None of 39 patients who received tetracycline developed subsequent neurologic, cardiac, or joint abnormalities, compared with 3 of 40 penicillin-treated patients and 4 of 29 patients given erythromycin (P = 0.07). In 1982, all 49 patients were randomly assigned to receive tetracycline for either 10 or 20 days, and none of the patients in either group subsequently developed objective manifestations of Lyme disease. However, with all three regimens, nearly half of the patients had some minor symptoms after treatment, such as …
