Borrelia recurrentis Infection: Single-Dose Antibiotic Regimens and Management of the Jarisch-Herxheimer Reaction

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Abstract
For evaluation of single-dose antibiotic regimens in treatment of infection due to Borrelia recurrentis, 51 patients with louse-borne relapsing fever were randomly assigned either to one of two orally administered antibiotic regimens (500 mg of tetracycline or erythromycin) or to one of two parenterally administered regimens (250 mg of tetracycline given intravenously [iv] or 6 × 105 units of procaine penicillin G given intramuscularly [im]). Another 15 patients, who were given erythromycin orally, were randomly assigned to receive 1.3 g of acetaminophen orally, 1 g of hydrocortisone iv, or nothing in combination with erythromycin to evaluate the effect of these drugs on the severity of the Jarisch-Herxheimer reaction. Vital signs were measured hourly until they became stable, and blood smears were obtained hourly until they were negative for spirochetes. All patients survived, and there were no relapses. Orally administered tetracycline and erythromycin caused defervescence and cleared the blood of organisms equally rapidly and produced similar changes in temperature and blood pressure. Penicillin G given im produced defervescence more slowly than tetracycline given iv (14.4 hr vs. 10.5 hr) and cleared the blood of organisms more slowly than tetracycline (9.0 hr vs. 3.1 hr). Therapy with acetaminophen and hydrocortisone modified the changes in vital signs during the Jarisch-Herxheimer reaction but did not prevent rigor. It is concluded that a single oral dose of 500 mg of tetracycline or erythromycin is optimal therapy for B. recurrentis infection.

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