Between June 1981 and July 1987 the efficacy of
antibiotic treatment of 215 patients with
erythema chronicum migrans of
Lyme disease was evaluated in terms of the necessity for
retreatment and the prevention of the late manifestations of
Lyme disease. The principal
antibiotics utilized to treat 161 patients through 1986 were varying doses of
tetracycline, or
penicillin alone or in combination with
probenecid. Two of 80 patients with a minor form of the illness and 17 of 81 patients with a major form of the illness required
retreatment. There were four patients who did not respond to
retreatment with their original medication. A 15- to 30-day course of
amoxicillin (500 mg q.i.d.) and
probenecid (500 mg q.i.d.) or
doxycycline (100 mg t.i.d.), and on three occasions
ceftriaxone (2-4 g/day i.v.), were used to treat 54 patients in 1987. Although it is too early to judge the efficacy of treatment in these patients, increases in the incidence of Herxheimer reactions and
drug eruptions were observed. Strict compliance with treatment protocols and the possibility of reactions to medications should be thoroughly discussed with patients.