Journal Article

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

Todd J. Kowalski, Sujatha Tata, Wendy Berth, Michelle A. Mathiason and William A. Agger

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 50, issue 4, pages 512-520
Published in print February 2010 | ISSN: 1058-4838
Published online February 2010 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/649920
Antibiotic Treatment Duration and Long-Term Outcomes of Patients with Early Lyme Disease from a Lyme Disease–Hyperendemic Area

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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.

Journal Article.  3562 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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