Antibiotic Treatment Duration and Long-Term Outcomes of Patients with Early Lyme Disease from a Lyme Disease–Hyperendemic Area

Background. The length of antibiotic therapy and long-term outcomes in patients with early Lyme disease are incompletely described. We report the long-term clinical outcomes of patients with early localized and early disseminated Lyme disease based on the duration of antibiotic therapy prescribed. M...

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Bibliographic Details
Published in:	Clinical infectious diseases Vol. 50; no. 4; pp. 512 - 520
Main Authors:	Kowalski, Todd J., Tata, Sujatha, Berth, Wendy, Mathiason, Michelle A., Agger, William A.
Format:	Journal Article
Language:	English
Published:	Oxford The University of Chicago Press 15-02-2010 University of Chicago Press Oxford University Press
Subjects:	Adult Aged Amoxicillin - therapeutic use Anti-Bacterial Agents - therapeutic use Antibacterial agents Antibiotics Antibiotics. Antiinfectious agents. Antiparasitic agents ARTICLES AND COMMENTARIES Bacterial diseases Biological and medical sciences Borrelia Borrelia burgdorferi - isolation & purification Borrelia infections Clinical outcomes Cohort Studies Doxycycline - therapeutic use Drug therapy Endemic Diseases Erythema Female Health outcomes Health surveys Human bacterial diseases Humans Infections Infectious diseases Kaplan-Meier Estimate Lesions Lyme disease Lyme Disease - drug therapy Lyme Disease - epidemiology Male Medical diagnosis Medical sciences Medical treatment failures Middle Aged Pharmacology. Drug treatments Physicians Reinfection Retrospective Studies Surveys and Questionnaires Treatment Failure Treatment Outcome Tropical bacterial diseases Wisconsin - epidemiology Wisconsin Infection Human Lyme disease Antibiotic Prognosis Treatment Spirochaetosis Borrelia infection Bacteriosis Early stage Antibacterial agent Long term
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Summary:	Background. The length of antibiotic therapy and long-term outcomes in patients with early Lyme disease are incompletely described. We report the long-term clinical outcomes of patients with early localized and early disseminated Lyme disease based on the duration of antibiotic therapy prescribed. Methods. A retrospective cohort study and follow-up survey of patients diagnosed as having early localized and early disseminated Lyme disease from 1 January 2000 through 31 December 2004 was conducted in a Lyme disease–hyperendemic area. Results. Six hundred seven patients met the study inclusion criteria. Most patients (93%) were treated with doxycycline for treatment durations of ⩽10 days, 11–15 days, or ⩾16 days in 17%, 33%, and 47% of doxycycline-treated patients, respectively. Treatment failure criteria, defined before performing the study, were met in only 6 patients (1%). Although these 6 patients met a priori treatment failure criteria, 4 of these patients' clinical details suggested reinfection, 1 was treated with an inappropriate antibiotic, and 1 developed facial palsy early in therapy. Reinfection developed in 4% of patients. The 2-year treatment failure–free survival rates of patients treated with antibiotics for ⩽10 days, 11–15 days, or ⩾16 days were 99.0%, 98.9%, and 99.2%, respectively. Patients treated with antibiotics for ⩾16 days had lower 36-item Short-Form Health Survey social functioning scores on the follow-up survey. No other differences were found in follow-up clinical status or 36-item Short-Form Health Survey scores by duration of antibiotic treatment. Conclusions. Patients treated for ⩽10 days with antibiotic therapy for early Lyme disease have long-term outcomes similar to those of patients treated with longer courses. Treatment failure after appropriately targeted short-course therapy, if it occurs, is exceedingly rare.
Bibliography:	istex:B541417FA59D04240EF7B0E3C3AE38E548701608 ark:/67375/HXZ-XC3MR9PG-W ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	1058-4838 1537-6591
DOI:	10.1086/649920