Hansen K, Hovmark A, Lebech A M, Lebech K, Olsson I, Halkier-Sørensen L, Olsson E, Asbrink E
Department of Infection-Immunology, Statens Seruminstitut, Copenhagen, Denmark.
Acta Derm Venereol. 1992 Aug;72(4):297-300.
A new semisynthetic macrolide roxithromycin was evaluated for its potential use in the treatment of Lyme borreliosis. Using a macro-dilution broth technique, Borrelia burgdorferi was shown to be susceptible to roxithromycin with a minimal bactericidal concentration (MBC) of 0.06-0.25 microgram/ml. A systemic B. burgdorferi infection was established in gerbils; a dosage of greater than or equal to 25 mg/kg/day roxithromycin for 10 days eliminated the infection. A single blind, randomized multicenter study was performed to evaluate the efficacy of roxithromycin 150 mg b.i.d. versus phenoxymethyl-penicillin 1 g b.i.d. for 10 days in patients with uncomplicated erythema migrans. The study was interrupted when 19 patients had enrolled because of five treatment failures. All 5 patients had received roxithromycin; three patients had persisting or recurrent erythema migrans, one developed a secondary erythema migrans-like lesion and severe arthralgia and one developed neuroborreliosis. B. burgdorferi was isolated from skin biopsies after roxithromycin therapy from two patients with persistent erythema migrans and both isolates were still highly susceptible to roxithromycin (MBC = 0.03 microgram/ml). No treatment failures were seen in 10 patients treated with phenoxymethyl-penicillin. Roxithromycin is thus not recommended for treatment of Lyme borreliosis.
一种新型半合成大环内酯类药物罗红霉素被评估其在治疗莱姆病中的潜在用途。采用宏观稀释肉汤技术，显示伯氏疏螺旋体对罗红霉素敏感，其最低杀菌浓度（MBC）为0.06 - 0.25微克/毫升。在沙鼠中建立了全身性伯氏疏螺旋体感染；剂量大于或等于25毫克/千克/天的罗红霉素治疗10天可消除感染。进行了一项单盲、随机多中心研究，以评估150毫克罗红霉素每日两次与1克苯氧甲基青霉素每日两次治疗10天对无并发症游走性红斑患者的疗效。当纳入19例患者时，由于5例治疗失败该研究中断。所有5例患者均接受了罗红霉素治疗；3例患者游走性红斑持续或复发，1例出现继发性游走性红斑样皮损和严重关节痛，1例发生神经型莱姆病。在两名游走性红斑持续患者接受罗红霉素治疗后，从皮肤活检中分离出伯氏疏螺旋体，且两株分离菌对罗红霉素仍高度敏感（MBC = 0.03微克/毫升）。接受苯氧甲基青霉素治疗的10例患者未出现治疗失败。因此，不推荐使用罗红霉素治疗莱姆病。
