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.


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.
Kowalski
Todd J
TJ
Section of Infectious Disease and Departments of Medical Education, Gundersen Lutheran Medical Foundation, La Crosse, WI 54601. USA. TJKowals@gundluth.org
Tata
Sujatha
S
Berth
Wendy
W
Mathiason
Michelle A
MA
Agger
William A
WA
D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D025065:Borrelia burgdorferi / Q000302:isolation & purification; D015331:Cohort Studies; D004318:Doxycycline / Q000627:therapeutic use; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008193:Lyme Disease / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D016896:Treatment Outcome; D014922:Wisconsin / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D000658:Amoxicillin; D004318:Doxycycline