Benefit of intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease

Abstract

BackgroundWe have shown previously that extended intravenous antibiotic therapy is associated with low morbidity and no mortality in patients referred for treatment of neurologic Lyme disease. In this study, we evaluated the benefit of extended intravenous antibiotic therapy in patients with symptoms of neurologic Lyme disease.MethodsPatients with significant neurologic symptoms and positive testing for Borrelia burgdorferi were treated with intravenous antibiotics, and biweekly evaluation of symptom severity was performed using a six-level ordinal scale. Four symptoms were selected a priori as primary outcome measures in the study, ie, fatigue, cognition, myalgias, and arthralgias. Patients were placed into five groups according to time on treatment (1–4, 5–8, 9–12, 13–24, and 25–52 weeks), and changes in the primary symptoms as a function of time on treatment were analyzed using a mixed-effects proportional odds model.ResultsAmong 158 patients with more than one follow-up visit who were monitored for up to 1 year, there were on average 6.7 visits per person (median 5, range 2–24). The last follow-up day was on average 96 days after enrollment (median 69, range 7–354 days), corresponding to the length of antibiotic therapy. Each primary symptom was significantly improved at one or more time points during the study. For cognition, fatigue, and myalgias, the greatest improvement occurred in patients on the longest courses of treatment (25–52 weeks) with odds ratios (OR) for improvement of 1.97 (P = 0.02), 2.22 (P < 0.01), and 2.08 (P = 0.01), respectively. In contrast, arthralgias were only significantly improved during the initial 1–4 weeks of therapy (OR: 1.57, P = 0.04), and the beneficial effect of longer treatment did not reach statistical significance for this symptom.ConclusionProlonged intravenous antibiotic therapy is associated with improved cognition, fatigue, and myalgias in patients referred for treatment of neurologic Lyme disease. Treatment for 25–52 weeks may be necessary to obtain symptomatic improvement in these patients.

Lyme neuroborreliosis—epidemiology, diagnosis and management

“…Some believe that PTLDS is caused by persistent B. burgdorferi infection stemming from incomplete bacterial eradication by conventional antimicrobial therapy, and long-term antibiotic treatment and/or the use of other antimicrobials has been proposed as a treatment for PTDLS. 90,91 However, the absence of accompanying objective clinical symptoms and laboratory signs of inflammation counter the persistent infection hypothesis. Furthermore, prospective, placebo-controlled clinical trials have demonstrated minimal or no symptomatic improvement after long-term treatment with antibiotics in patients with PTLDS when compared with placebo.…”

“…99,100 Two assumptions accompany the diagnosis: first, that chronic Lyme disease is caused by ongoing cryptic infection with morphological variants of B. burgdorferi; [101][102][103][104] and second, that this form of infection is unresponsive to conventional antimicrobial treatment, instead requiring longterm therapy with antibiotics of different classes. 91,100,105 In many instances, patients diagnosed with chronic Lyme disease are also diagnosed with chronic co-infections of other tick-borne pathogens. 106 Recent review articles have demonstrated that the current medical literature supports neither a role for persistent infection 107 nor a role for morphological variants of B. burgdorferi in chronic Lyme disease.…”

Chronic Lyme Disease

“…Other studies reiterate the frequency of adverse events in persons with prolonged exposure to IV catheters and antibiotics. In an observational study by Stricker and colleagues, 109 there were 19 potentially life-threatening adverse events among 200 patients on long-term IV antibiotics for the treatment of CLD. These included 4 cases of venous thromboembolic disease, 6 cases of suspected line sepsis, 7 patients with allergic reactions, and 2 who developed ceftriaxone-induced gallbladder disease (both necessitating cholecystectomy).…”

The clinical significance of biochemical failure in the first 2 years in patients treated with neo-adjuvant androgen deprivation and radiotherapy for prostate cancer

“…The fact that B. burgdorferi shares resistance genes with pathogenic mycobacteria supports the need for doi: 10.7243/2052-5958-1-2 this therapeutic approach [30,31]. It remains to be seen which form of B. burgdorferi is the true culprit in chronic Lyme disease and which form of treatment is most efficacious in clearing both forms of bacteria from patients [32][33][34][35][36][37][38]. …”