A1 Journal article – refereed

Oral Doxycycline Compared to Intravenous Ceftriaxone in the Treatment of Lyme Neuroborreliosis: A Multicenter, Equivalence, Randomized, Open-label Trial

List of Authors: Elisa Kortela, Mari J Kanerva, Juha Puustinen, Saija Hurme, Laura Airas, Anneli Lauhio, Ulla Hohenthal, Päivi Jalava-Karvinen, Tuomas Nieminen, Taru Finnilä, Tony Häggblom, Annukka Pietikäinen, Mari Koivisto, Johanna Vilhonen, Minna Marttila-Vaara, Jukka Hytönen, Jarmo Oksi

Publication year: 2020

Journal: Clinical Infectious Diseases

DOI: http://dx.doi.org/10.1093/cid/ciaa217


Lyme neuroborreliosis (LNB) is often treated with intravenous ceftriaxone even if doxycycline is suggested to be noninferior to ceftriaxone. We evaluated the efficacy of oral doxycycline in comparison to ceftriaxone in the treatment of LNB.


Patients with neurological symptoms suggestive of LNB without other obvious reasons were recruited. The inclusion criteria were (1) production of Borrelia burgdorferi–specific antibodies in cerebrospinal fluid (CSF) or serum; (2) B. burgdorferi DNA in the CSF; or (3) an erythema migrans during the past 3 months. Participants were randomized in a 1:1 ratio to receive either oral doxycycline 100 mg twice daily for 4 weeks, or intravenous ceftriaxone 2 g daily for 3 weeks. The participants described their subjective condition with a visual analogue scale (VAS) from 0 to 10 (0 = normal; 10 = worst) before the treatment, and 4 and 12 months after the treatment. The primary outcome was the change in the VAS score at 12 months.


Between 14 September 2012 and 28 December 2017, 210 adults with suspected LNB were assigned to receive doxycycline (n = 104) or ceftriaxone (n = 106). The per-protocol analysis comprised 82 patients with doxycycline and 84 patients with ceftriaxone. The mean change in the VAS score was −3.9 in the doxycycline group and −3.8 in the ceftriaxone group (mean difference, 0.17 [95% confidence interval, −.59 to .92], which is within the prespecified equivalence margins of −1 to 1 units). Participants in both groups improved equally.


Oral doxycycline is equally effective as intravenous ceftriaxone in the treatment of LNB.

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Last updated on 2021-24-06 at 08:10