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Treatment and course of erythema chronicum migrans
Abstract:
72 patients with Erythema chronicum migrans were treated with phenoxymethyl penicillin, 1,5 mill. IU p.o. three times a day for 14 days. Two children got the same therapy, but in a dosage of 400,000 IU three times a day for 10 days. In three of 15 skin samples, taken from the periphery of ECM lesions, spirochetal organisms were isolated. Of the 72 patients 16 had raised IgG (greater than or equal to 128) and 9 had raised IgM (greater than or equal to 64) titers to Borrelia burgdorferi. Under treatment with phenoxymethyl penicillin (penicillin V) all ECM lesions resolved within 6 to 10 days. After an observation period of 9 to 14 months no major or minor late manifestations of Lyme disease have developed in any of the 72 patients.
Insights
Phenoxymethyl penicillin effectively treated Erythema chronicum migrans (ECM) in 72 patients. All patients experienced lesion resolution and showed no late Lyme disease manifestations after follow-up.
Area of Science:
- Infectious Diseases
- Dermatology
- Microbiology
Background:
- Erythema chronicum migrans (ECM) is an early manifestation of Lyme disease.
- Spirochetal organisms, specifically Borrelia burgdorferi, are the causative agents of Lyme disease.
- Previous treatment protocols for ECM varied, necessitating evaluation of antibiotic efficacy.
Purpose of the Study:
- To assess the efficacy and safety of phenoxymethyl penicillin (penicillin V) in treating Erythema chronicum migrans.
- To evaluate the resolution rate of ECM lesions and the incidence of late Lyme disease manifestations following treatment.
Main Methods:
- A cohort of 72 patients with ECM received phenoxymethyl penicillin (1.5 million IU t.i.d. for 14 days).
- Two pediatric patients received a lower dose (400,000 IU t.i.d. for 10 days).
- Skin biopsies were analyzed for spirochetal presence; serological titers (IgG, IgM) to Borrelia burgdorferi were measured.
Main Results:
- Phenoxymethyl penicillin treatment resulted in the resolution of all ECM lesions within 6 to 10 days.
- No major or minor late manifestations of Lyme disease were observed in any patient during a 9 to 14-month follow-up period.
- Spirochetal organisms were isolated from three of 15 skin samples taken from ECM lesion peripheries.
Conclusions:
- Phenoxymethyl penicillin is an effective treatment for Erythema chronicum migrans.
- The observed treatment regimen prevents the development of late-stage Lyme disease manifestations.
- Penicillin V demonstrates a favorable safety profile for ECM treatment.