Azithromycin gel fails to prevent Lyme disease

In a recent study conducted in Germany and Austria, researchers applied a 10% azithromycin gel to the site of a tick bite for 3 days. The trial was stopped early after it failed to prove that the gel worked in preventing Lyme disease (LD) for the 995 subjects. The topical treatment failed to prevent a combination of seroconversion or an EM rash in 11 (2%) of 505 individuals in the azithromycin group and 11 (2%) of 490 participants in the placebo group.


by Daniel J. Cameron, MD MPH

The findings of this double-blinded placebo controlled clinical trial were published in The Lancet Infectious Disease. In a post hoc analysis of 134 subjects, the authors were able to prevent 6 rashes if the gel was applied after a tick bite. The gel delayed the onset of EM rashes by 33 and 51 days, respectively, in an additional two subjects.[1]

The trial did not show that the 10% azithromycin gel could prevent Lyme disease. It only demonstrated that the gel could prevent or delay a few EM rashes in a subset of patients bitten by a tick.

It would be nice to have a quick fix to prevent Lyme disease following a tick bite. But treatment with azithromycin gel is not the answer. Based on this trial, the gel should not be used to prevent Lyme disease.


  1. Schwameis, M., et al., Topical azithromycin for the prevention of Lyme borreliosis: a randomised, placebo-controlled, phase 3 efficacy trial. Lancet Infect Dis, 2016.

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