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

doi:10.1001/archneur.1989.00520470044025

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Vol. 46 No. 11, November 1989

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Cefotaxime vs Penicillin G for Acute Neurologic Manifestations in Lyme Borreliosis

A Prospective Randomized Study

Hans-Walter Pfister, MD; Vera Preac-Mursic, PhD; Bettina Wilske, MD; Karl Max Einhäupl, MD

Arch Neurol. 1989;46(11):1190-1194.

Abstract

• We randomly assigned 21 patients with painful Lyme neuroborreliosisradiculitis (Bannwarth's syndrome) and neuroborreliosis meningitisto a 10-day treatment with either penicillin G, 4 X 5 millionU/d (n = 10) or cefotaxime sodium, 3X2 g/d (n = 11), intravenously.We were not able to demonstrate clinical differences betweengroups, either during the 10-day treatment period or at follow-upexamination a mean of 7.7 months after antibiotic therapy. Cerebrospinalfluid cefotaxime concentrations reached the minimum inhibitoryconcentration at the 90% level for Borrelia burgdorferi in allpatients, while none of the patients treated with penicillinG had cerebrospinal fluid concentrations above the minimum inhibitoryconcentration at the 90% value. We conclude that patients withacute neurologic manifestations of Lyme borreliosis may benefitfrom a 10-day treatment with cefotaxime or penicillin G. Cerebrospinalfluid antibiotic concentrations above the minimum inhibitoryconcentration at the 90% value, as observed in all patientstreated with cefotaxime, offer the most hope for long-term prognosis.

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.

Footnotes

Accepted for publication March 17, 1989.

Reprint requests to Neurologische Klinik der Universität,Klinikum Groβhadern, Marchioninistrasse 15, 8000 München70, West Germany (Dr Pfister).

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