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November 1989

Cefotaxime vs Penicillin G for Acute Neurologic Manifestations in Lyme Borreliosis: A Prospective Randomized Study

Author Affiliations

From the Neurologische Klinik der Universität, Klinikum Groβhadern (Drs Pfister and Einhäupl), and the Max von Pettenkofer Institut für Mikrobiologie und Hygiene, Ludwig Maximilians Universität München (Drs Preac-Mursic and Wilske), Munich, West Germany.

Arch Neurol. 1989;46(11):1190-1194. doi:10.1001/archneur.1989.00520470044025

• 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, 3X2 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.

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