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NCT Number: NCT01518192

Comparison of Doxycycline and Cefuroxime Axetil for Treatment of Erythema Migrans: Clinical and Microbiological Outcome

Background:

* While doxycycline is a standard antibiotic for treatment of erythema migrans in Europe as well as in the USA, the effectiveness of cefuroxime axetil in the treatment of adult patients with erythema migrans has been assessed only in the USA where the causative agent of Lyme disease is Borrelia burgdorferi, but not in Europe where the main etiologic agents are B. afzelii and B. garinii. * Controversy exists over the significance and even the existence of post-Lyme disease symptoms because of the high rate of similar background symptoms in the general population.

Purpose:

The two main purposes of this European, prospective clinical trial in which doxycycline and cefuroxime axetil are compared in the treatment of adult patients with erythema migrans and which included a control group to address the significance of post-Lyme disease symptoms are:

* To assess and compare the effectiveness of doxycycline and cefuroxime axetil in the treatment of erythema migrans using clinical and bacteriological criteria (noninferiority testing approach), and * to compare the frequency of post-Lyme disease symptoms in adult patients treated for EM with antibiotics and the frequency of similar symptoms in control subjects without Lyme disease.

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Key information

Conditions

Erythema Migrans Glossitis Glossitis, Benign Migratory Mouth Diseases Post-Lyme Disease Symptoms Stomatognathic Diseases Tongue Diseases

Age range

15 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Phase 4

Primary location

Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia, Ljubljana, Slovenia

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About this study

Sample size

Decisions were based on the following:

  • Number of patients with erythema migrans treated with doxycycline and cefuroxime axetil was determined assuming no difference in treatment outcome will be detected (non-inferiority testing).
  • The decision for a larger sample sizes than needed for 1. was done with the intention to evaluate the secondary outcome measure, i.e., to assess the difference between the frequency of new or increased symptoms in patients treated for early Lyme disease and the occurrence of the same symptoms in control subjects.
  • We assumed that the outcomes in the two treatment groups will be comparable and that the patients could be combined for further analysis.
  • To obtain a control group from the same geographical area, each patient was asked if she or he had a family member or friend who was within 5 years of her or his age and who was without a history of Lyme borreliosis. These persons were approached by a short written explanation of the investigation, containing also a request for their participation. We assumed that we will be able to get a corresponding control person not for all but for approximately 80-90% of patients.
  • Under the assumption that approximately 15% of an estimated 200 patients would have new or increased symptoms at >6 months after enrollment into the study, a control group of 165 subjects would be sufficient to detect a >10 percentage point lower rate of new or increased symptoms in controls compared with patients at the 0.05 level (2-sided) with >90% power. To comply with drop outs at different time points we assessed that 280 patients and 230 controls should be included at baseline.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • patients 15 or more years old
  • with typical erythema migrans
  • evaluated between 6/06 and 9/06
  • evaluated at the Lyme Disease Outpatient Clinic, University Medical Center Ljubljana, Slovenia.

Exclusion criteria

  • history of Lyme disease in the past
  • pregnancy
  • lactation
  • immunocompromising condition
  • history of a serious adverse reaction to a beta-lactam or tetracycline drug
  • receiving an antibiotic with known anti-borrelial activity within 10 days
  • multiple erythema migrans lesions or an extracutaneous manifestation of Lyme disease.

Treatment and study plan

Doxycycline

Drug

100 mg bid; 15 days

Cefuroxime Axetil

Drug

500 mg bid; 15 days

Primary outcomes

  1. Objective Lyme Disease Manifestations and Post-Lyme Disease Symptoms at 14 Days

    Time frame: at 14 days post inclusion

    Number of patients with objective manifestations of Lyme disease(persistence of erythema migrans or any of the extracutaneous-cardiac, nervous or skeletal-Lyme disease manifestations)and/or with post-Lyme disease symptoms in patients treated for solitary erythema migrans at 14 days post inclusion

  2. Adverse Events

    Time frame: at 14 days

    Number of patients reporting adverse events

  3. Objective Lyme Disease Manifestations and Post-Lyme Disease Symptoms at 2 Months

    Time frame: 2 months

    Number of patients with objective Lyme disease manifestations and/or post-Lyme disease symptoms in patients treated for solitary erythema migrans at 2 months post inclusion

  4. Objective Lyme Disease Manifestations and Post-Lyme Disease Symptoms at 6months

    Time frame: 6 months

    Number of patients with objective Lyme disease manifestations and/or post-Lyme disease symptoms in patients treated for solitary erythema migrans at 6 months post inclusion

  5. Objective Lyme Disease Manifestations and Post-Lyme Disease Symptoms at 12 Months

    Time frame: 12 months

    Number of patients with objective Lyme disease manifestations and/or post-Lyme disease symptoms in patients treated for solitary erythema migrans at 12 months post inclusion

Secondary outcomes

  1. New or Increased Symptoms Since Erythema Migrans in Patients and Controls at 6 Months.

    Time frame: 6 months

    Comparison of the number patients and controls with new or increased symptoms since erythema migrans at 6 months.

  2. New or Increased Symptoms Since Erythema Migrans in Patients Controls at 12 Months.

    Time frame: 12 months

    Comparison of the number of patients and controls with new or increased symptoms since erythema migrans at 12 months.

  3. Selected Subjective Symptoms in Patients and Control Subjects

    Time frame: Examination at 12 months

    Comparison of the number of patients and controls with selected 8 symptoms (fatigue, arthralgias, myalgias, headache, paresthesias, dizziness, irritability, or nausea) within the preceding week, irrespective of whether they were new or increased since erythema migrans.

Sponsors and collaborators

Lead sponsor

University Medical Centre Ljubljana

Other

Collaborators

  • Slovenian Research Agency

Registry information

Official study title

Risk Factors for Failure of Erythema Migrans Treatment - Comparison of Doxycycline and Cefuroxime Axetil for Treatment of Adult Patients With Erythema Migrans: Clinical and Microbiological Outcome.

Important dates

Study start
2006
Primary completion
2007
Study completion
2009
First posted
Jan 25, 2012
Registry last updated
Jan 25, 2012

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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