Arnez M, Radsel-Medvescek A, Pleterski-Rigler D, Ruzić-Sabljić E, Strle F
Department of Infectous Diseases, University Medical Centre, Ljubljana, Slovenia.
Wien Klin Wochenschr. 1999 Dec 10;111(22-23):916-22.
To compare the clinical efficacy and drug-related adverse effects of 14 days of treatment with cefuroxime axetil 30 mg/kg/day or phenoxymethyl penicillin 100,000 IU/kg/day in the treatment of children with erythema migrans.
Consecutive patients younger than 15 years, referred to our institution in 1996 with solitary erythema migrans and without prior antibiotic therapy, were included in this prospective study. Basic demographic features and clinical data were collected by questionnaire. The efficacy of the treatment of acute disease, development of major and/or minor manifestations of Lyme borreliosis and drug-related adverse effects were surveyed at follow-up visits during the first year after the initiation of antibiotic treatment.
Forty-six patients received cefuroxime axetil (group C) and 44, phenoxymethyl penicillin (group P). The two groups differed in terms of age (patients in group C were younger), but no other differences in demographic and clinical pre-treatment characteristics were present. The clinical course during the post-treatment period revealed no significant differences between the two groups: the duration of erythema migrans (7.1 +/- 7.5 days in group C, 10.6 +/- 19.3 days in group P) and the appearance of minor manifestations of Lyme borreliosis (8.8% in group C, 9.1% in group P) were comparable; no major manifestations were recorded. Twelve months after antibiotic treatment all patients were free of symptoms. The patients treated with cefuroxime axetil had more drug-related adverse effects than did those treated with phenoxymethyl penicillin (26.1% versus 6.8%, p = 0.0301). "Herxheimer's reaction" at the beginning of treatment was identified more often in group C than in group P, but the difference was not statistically significant.
Cefuroxime axetil and phenoxymethyl penicillin are equally effective in the treatment of children with solitary erythema migrans; however drug-related adverse effects were more frequently observed with cefuroxime axetil.
比较用头孢呋辛酯30mg/kg/天或苯氧甲基青霉素100,000IU/kg/天治疗14天对游走性红斑患儿的临床疗效及药物相关不良反应。
1996年转诊至我院的年龄小于15岁、患有孤立性游走性红斑且未接受过抗生素治疗的连续患者被纳入这项前瞻性研究。通过问卷调查收集基本人口统计学特征和临床数据。在抗生素治疗开始后的第一年随访中，调查急性疾病的治疗效果、莱姆病螺旋体病主要和/或次要表现的发生情况以及药物相关不良反应。
46例患者接受头孢呋辛酯治疗（C组），44例接受苯氧甲基青霉素治疗（P组）。两组在年龄方面存在差异（C组患者年龄较小），但在人口统计学和临床治疗前特征方面无其他差异。治疗后期间的临床病程显示两组之间无显著差异：游走性红斑持续时间（C组为7.1±7.5天，P组为10.6±19.3天）和莱姆病螺旋体病次要表现的出现情况（C组为8.8%，P组为9.1%）具有可比性；未记录到主要表现。抗生素治疗12个月后所有患者均无症状。接受头孢呋辛酯治疗的患者比接受苯氧甲基青霉素治疗的患者有更多药物相关不良反应（26.1%对6.8%，p = 0.0301）。治疗开始时的“赫克斯海默反应”在C组比P组更常出现，但差异无统计学意义。
头孢呋辛酯和苯氧甲基青霉素在治疗孤立性游走性红斑患儿方面同样有效；然而，头孢呋辛酯更常观察到药物相关不良反应。
