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Author: Admin | 2025-04-28
The drug.Spirochetal InfectionsLyme DiseaseErythromycin, azithromycin, or clarithromycin has been used in the treatment of early Lyme disease†, a spirochetal disease caused by tick-borne Borrelia burgdorferi. However, some evidence in patients with early Lyme disease suggests that certain macrolides (e.g., azithromycin, erythromycin) may be less effective than penicillins or tetracyclines, and the IDSA, AAP, and other clinicians recommend that macrolide antibiotics not be used as first-line therapy for early Lyme disease. Oral doxycycline or oral amoxicillin is recommended as first-line therapy for the treatment of early localized or early disseminated Lyme disease associated with erythema migrans, in the absence of neurologic involvement or third-degree atrioventricular (AV) heart block; alternatively, oral cefuroxime axetil has been used. Therapy with a macrolide antibiotic generally is recommended for the treatment of early Lyme disease in patients who are allergic to or intolerant of penicillins and cephalosporins and in whom tetracyclines are contraindicated (e.g., pregnant or lactating women and children younger than 8–9 years of age). While therapy with clarithromycin (500 mg twice daily for 21 days) appeared to be effective in resolving manifestations of early Lyme disease in a limited number of patients in an open-label study, the IDSA and other clinicians state that macrolide antibiotics should be reserved for patients who are intolerant of amoxicillin, doxycycline, and cefuroxime axetil and that patients treated with macrolides should be monitored closely.The IDSA, AAP, and other clinicians recommend that patients with more severe forms or late complications of Lyme disease generally receive a higher dosage, more prolonged therapy, and/or parenteral anti-infectives (e.g., IV ceftriaxone, IV cefotaxime, or IV penicillin G for 2–4 weeks). SyphilisThe manufacturers suggest that oral erythromycin can be used for the treatment of primary syphilis. Although the CDC previously suggested use of oral erythromycin as an alternative agent for the treatment of primary or secondary syphilis in nonpregnant adults and adolescents hypersensitive to penicillins, erythromycin is less effective than other possible penicillin alternatives and is no longer included in CDC recommendations for the treatment of any form of syphilis in adults or adolescents (including primary, secondary, latent, or tertiary syphilis or neurosyphilis). Penicillin G
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