Cefotaxime vs penicillin G for acute neurologic manifestations in Lyme borreliosis. A prospective randomized study.

Abstract

We randomly assigned 21 patients with painful Lyme neuroborreliosis radiculitis (Bannwarth's syndrome) and neuroborreliosis meningitis to a 10-day treatment with either penicillin G. 4 x 5 million U/d (n = 10) or cefotaxime sodium, 3 x 2 g/d (n = 11), intravenously. We were not able to demonstrate clinical differences between groups, either during the 10-day treatment period or at follow-up examination a mean of 7.7 months after antibiotic therapy. Cerebrospinal fluid cefotaxime concentrations reached the minimum inhibitory concentration at the 90% level for Borrelia burgdorferi in all patients, while none of the patients treated with penicillin G had cerebrospinal fluid concentrations above the minimum inhibitory concentration at the 90% value. We conclude that patients with acute neurologic manifestations of Lyme borreliosis may benefit from a 10-day treatment with cefotaxime or penicillin G. Cerebrospinal fluid antibiotic concentrations above the minimum inhibitory concentration at the 90% value, as observed in all patients treated with cefotaxime, offer the most hope for long-term prognosis.

• Authors: H W Pfister, V Preac-Mursic, B Wilske, K M Einhäupl
• Journal: Archives of neurology (Arch Neurol) Vol. 46 Issue 11 Pg. 1190-4 (Nov 1989) ISSN: 0003-9942 [Print] United States
• PMID: 2684107 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Cefotaxime
• Penicillin G

Topics

• Acute Disease
• Aged
• Cefotaxime (therapeutic use)
• Female
• Humans
• Lyme Disease (drug therapy)
• Male
• Middle Aged
• Nervous System Diseases (drug therapy)
• Penicillin G (therapeutic use)
• Prospective Studies
• Radiculopathy (drug therapy)