Safety of intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease.
OBJECTIVE
Although intravenous antibiotic therapy is recommended for neurologic Lyme disease, safety concerns have been raised about treatment beyond 30 days in patients with persistent neurologic symptoms. The goal of our study was to evaluate the safety of extended intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease.


METHODS
We enrolled 200 consecutive patients with significant neurologic symptoms and positive testing for Borrelia burgdorferi. Patients were treated with intravenous antibiotics using various intravascular devices (IVDs). Standard IVD care was administered to all patients, and monitoring for medication reactions and IVD complications was performed on a weekly basis.


RESULTS
The mean length of intravenous antibiotic treatment was 118 days (range, 7-750 days) representing 23,654 IVD-days. Seven patients (3.5%) experienced allergic reactions to the antibiotic medication, and two patients (1.0%) had gallbladder toxicity. IVD complications occurred in 15 patients (7.5%) representing an incidence of 0.63 per 1,000 IVD-days. The IVD problems occurred an average of 81 days after initiation of treatment (range, 7-240 days). There were six suspected line infections for an incidence of 0.25 per 1,000 IVD-days. Only one of the IVD infections was confirmed, and no resistant organisms were cultured from any patient. None of the IVD complications were fatal.


CONCLUSIONS
Prolonged intravenous antibiotic therapy is associated with low morbidity and no IVD-related mortality in patients referred for treatment of neurologic Lyme disease. With proper IVD care, the risk of extended antibiotic therapy in these patients appears to be low.
Union Square Medical Associates, San Francisco, CA, USA. rstricker@usmamed.com
R B
RB
Stricker
C L
CL
Green
V R
VR
Savely
S N
SN
Chamallas
L
L
Johnson
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002648:Child; D004334:Drug Administration Schedule; D004342:Drug Hypersensitivity / Q000209:etiology; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000295:instrumentation; D007275:Injections, Intravenous / Q000009:adverse effects / Q000295:instrumentation; D020852:Lyme Neuroborreliosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013927:Thrombosis / Q000139:chemically induced; D001743:Urinary Bladder / Q000187:drug effects; D055815:Young Adult
D000900:Anti-Bacterial Agents