Bactrim forte 200 mg /24 h in a single dose (0.1 mg/kg, 0.4-0.6 ml, subcutaneous), but did not significantly reduce bleeding in rats that had been pretreated with penicillin (2% cephalosporin) (Ravitch, 1992; Whelan et al., 1996) with similar efficacy (1/4 and 2/6 rats, respectively).
Although most B. burgdorferi infection is of the early and chronic phase, a small number of patients with fulminant Borreliosis may develop disseminated infection and are sometimes hospitalized with symptoms that can progress rapidly to hemolytic anemia. One study reported that pretreatment for an infected individual prior to hospitalization with cefotaxime and rifampin could prevent the development of fulminant disease after hospitalization (Ravitch 1994).
Antibiotic treatment alone has been shown to improve morbidity and prolong life in several animal studies. This was also true for treatment with doxycycline. In one study, treatment with doxycycline and clindamycin was associated with a 24-day increased mortality rate compared to placebo treatment during which all animals suffered from some degree of severe illness (Doolittle et al., 1975). A review of six published cases showed that antibiotic treatment of fulminant disease had a significant impact on outcome: in six of the cases antibiotics were not effective, but in two of these six cases it was associated with a clinical improvement (Ferguson, 1979; Wahl et al., 1987; Whelan 1996). An earlier study of 10 consecutive patients after clinical therapy with cephalosporins and doxycycline found the mortality rate significantly improved with use of cephalosporin therapy compared to placebo treatment (Ravitch, 1987). In another study, the rate of mortality in a group four patients with fulminant Borreliosis who received antibiotic treatment was significantly reduced with cefotaxime alone or in combination with doxycycline and rifampin (Ravitch et al., 1981). In a third study, the rate of fatal illness after three weeks initiation of antibiotic treatment was 50% after administration of doxycycline alone or in combination with rifampin (Whelan et al., 1996). The mortality rate in a group of 23 subjects with mild symptomatic patients Borreliosis was reduced to 30% by early initiation of rifampin treatme
