Antibiotic Treatment Duration and Long-Term Outcomes of Patients With Early Lyme Disease From a Lyme Disease-Hyperendemic Area

Clin Infect Dis. 2010 Feb 15;50(4):512-20. doi: 10.1086/649920.

Abstract

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.

MeSH terms

  • Adult
  • Aged
  • Amoxicillin / therapeutic use
  • Anti-Bacterial Agents / therapeutic use*
  • Borrelia burgdorferi / isolation & purification
  • Cohort Studies
  • Doxycycline / therapeutic use
  • Endemic Diseases*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Lyme Disease / drug therapy*
  • Lyme Disease / epidemiology*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Surveys and Questionnaires
  • Treatment Failure
  • Treatment Outcome
  • Wisconsin / epidemiology

Substances

  • Anti-Bacterial Agents
  • Amoxicillin
  • Doxycycline