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Comparing 3 Antibiotic Regimes for Erythema Migrans in General Practice (NorTick_EM)

This study has been completed.
Norwegian Institute of Public Health
Sorlandet Hospital HF
Norwegian University of Life Sciences
Information provided by (Responsible Party):
Morten Lindbaek, University of Oslo Identifier:
First received: June 6, 2011
Last updated: December 11, 2014
Last verified: December 2014
Tick borne diseases are increasing in Norway. Lyme borreliosis is the most common infection. Erythema migrans is mainly diagnosed and treated in general practice. There is disagreement about what antibiotic treatment that should be given. An RCT with the three most common antibiotics used, will support data for revision of national guidelines.

Condition Intervention Phase
Erythema Migrans Erythema Chronicum Migrans Borreliosis Lyme Disease Early Lyme Disease Drug: Doxycycline Drug: Phenoxymethylpenicillin Drug: Amoxicillin Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple (Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Tick Borne Diseases in Norwegian General Practice. A Randomized, Controlled Trial for Treatment of Erythema Migrans in Norwegian General Practice. A Comparison of Phenoxymethylpenicillin, Amoxicillin and Doxycycline.

Resource links provided by NLM:

Further study details as provided by Morten Lindbaek, University of Oslo:

Primary Outcome Measures:
  • Duration of Erythema migrans (EM) [ Time Frame: 1-90 days ]
    On day 1 duration until first the consulation is registered. Day 1-14 the EM is registered in a patient diary. On day 14 the doctor is asked whether the EM has disseapeared. If not the patient is followed by phone from the researchers. On day 90 they are additionally asked for how long it lasted.

Secondary Outcome Measures:
  • Subjective Health Complaints (SHC) [ Time Frame: 1 year ]
    By questionnaire on day 1, day 90 and day 360 the patients are asked about their SHC which is a standardized set of parametres. The 3 treatment groups are compaired to each other and to 1200 healthy blood donors receiving the same questionnaire. There are 29 standardized and 3 Lyme disease related subjects to be measured.

  • Borrelia antibodies [ Time Frame: 1-90 days ]
    Normally antibody production is not measured for EM as it is a clinical diagnosis, and less than 50 percent of EM-patients are expected to develop antibodies in the first period. However antibodies are here measured on day 1, day 14 and day 90 to see whether there are differences between the groups. Also the results will be compared to the blood donors.

  • Side symptoms [ Time Frame: 1-14 days ]

    The EM in it self is often asymptomatic, and fever, headache and nerval palsy can be a sign of disseminated disease or co-infection. On the quiestionnaire to the pasient and doctor on day 1, in the patient diary day 1-14 and on the questionnaire to the doctor on day 14 these side symptoms are registered.

    In a potential case, where it turns out that the patient suffers from disseminated disease this will be regostered as treatment failure in the study and the patient treated and/or referred as normal.

  • Side effects [ Time Frame: 1-14 days ]
    The antibiotic tretments are expected to be non-inferior to each other. Potensial side effects as nausea, diarrhea etc. are registered in the patients diary day 1-14 and in the doctors quiestionnaire on day 14.

  • Subgrouping and TBE [ Time Frame: 1-14 days ]
    For volunteers there is an additional PCR-analysis on punch biopsy from the EM for subgroupring of the Borrelia bacteria. TBE-antibodies are measured on day 14.

Estimated Enrollment: 225
Study Start Date: June 2011
Study Completion Date: December 2014
Primary Completion Date: December 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: Doxycycline
Doxycycline, 100 mg, tablets, b.i.d., 14 days
Drug: Doxycycline
1 tablet, 100 mg, b.i.d. 14 days
Other Name: Doksycycline 100 mg HEXAL, no. 30
Active Comparator: Penicillin
Phenoxymethylpenicillin tablets 650 mg. 2 tablets t.i.d. 14 days
Drug: Phenoxymethylpenicillin
Tablet 650 mg, 2 tablets, t.i.d., 14 days
Other Name: Weifapenin 650 mg, WEIFA, no. 100
Active Comparator: Amoxicillin
Amoxicillin 500 mg capsula, t.i.d., 14 days
Drug: Amoxicillin
Capsula, 500 mg, t.i.d., 14 days
Other Name: Amoxicillin 500 mg MYLAN, no. 30 + 20.

Detailed Description:
Comparison of phenoxymethylpenicillin, doxycycline and amoxicillin for Erythema migrans in Norwegian general practice. Every patient receives 14 days of antibiotic treatment. There are blood samples for measurement of Borrelia antibody level at day 1, 14 and 90 and questionnaires on subjective health complaints (SHC) at day 1, 90 and 360. Side symptoms and side effects are registered. For volunteers there is an additional PCR-analysis on punch biopsy from the EM for subgrouping of the Borrelia bacteria. TBE-antibodies are measured on day 14. Antibody levels and SHC-scores are compared to healthy blood donors.

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Clinical diagnosis of Erythema migrans
  • Over the age of 18
  • Signing an concent form after information in writing

Exclusion Criteria:

  • Allergic to any of the three drugs in the study
  • Under the age of 18
  • Pregnancy
  • Dementia or known drug abuse
  • Antibiotic treatment last 14 days
  • Concommitant Chemotherapy or immunomodulating therapy
  • Concommitant use of medicine with potential interaction (defined in protocol)
  Contacts and Locations
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Please refer to this study by its identifier: NCT01368341

Antibiotic Centre for Primary Care, University of Oslo
Oslo, Norway, 0318
Sponsors and Collaborators
Morten Lindbaek
Norwegian Institute of Public Health
Sorlandet Hospital HF
Norwegian University of Life Sciences
Principal Investigator: Morten Lindbak, Professor University of Oslo
  More Information

Additional Information:
Responsible Party: Morten Lindbaek, Professor, University of Oslo Identifier: NCT01368341     History of Changes
Other Study ID Numbers: EUDRACT 2010-023747
Study First Received: June 6, 2011
Last Updated: December 11, 2014

Keywords provided by Morten Lindbaek, University of Oslo:
General Practice
Erythema migrans

Additional relevant MeSH terms:
Lyme Disease
Erythema Chronicum Migrans
Glossitis, Benign Migratory
Skin Diseases
Borrelia Infections
Gram-Negative Bacterial Infections
Bacterial Infections
Tick-Borne Diseases
Spirochaetales Infections
Skin Diseases, Bacterial
Skin Diseases, Infectious
Tongue Diseases
Mouth Diseases
Stomatognathic Diseases
Anti-Bacterial Agents
Penicillin V
Anti-Infective Agents
Antiprotozoal Agents
Antiparasitic Agents processed this record on September 21, 2017