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. [For descriptions of the three stages of Lyme signs & symptoms, click here.]
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.
• 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.
Source: Clinical Infectious Diseases, Feb 2010.15;50(4):512-20.PMID: 20070237, by Kowalski TJ, Tata S, Berth W, Mathiason MA, Agger WA. Section of Infectious Disease and Departments of Medical Education, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin, USA. [E-mail: TJKowals@gundluth.org]