title: Treatment complications in children with lyme meningitis.
abstract: BACKGROUND
  The rate and type of treatment complications in children treated for Lyme meningitis have not been described.
  
  
  METHODS
  We performed a retrospective cohort study of children with Lyme meningitis who presented to 1 of 3 emergency departments located in Lyme disease endemic areas between 1997 and 2010. We defined a case of Lyme meningitis as a child with cerebrospinal fluid pleocytosis and either positive Lyme serology or an erythema migrans rash. We identified prescribed treatment and reasons for all return visits. Our primary outcome was the presence of any treatment complication within 30 days of diagnosis.
  
  
  RESULTS
  We identified 157 patients with Lyme meningitis with a median age of 10 years (interquartile range: 7-13 years). Of the 149 children with Lyme meningitis and available follow-up records, 39 (26%) had 1 or more complications, and 21 (14%) required a change in prescribed antibiotic therapy. The median time for developing the first complication was 11 days (interquartile range: 9-14 days). Ten percent of the patients had an adverse drug reaction. Of the 144 children who had a peripherally inserted central catheter placed, 25 (17%) had at least 1 peripherally inserted central catheter-associated complication: 14 (10%) had a mechanical problem, 11 (8%) had an infectious complication and 1 (1%) had a venous thromboembolism.
  
  
  CONCLUSIONS
  As current Lyme meningitis treatment regimens have substantial associated morbidity, future research should investigate the efficacy of alternate regimens.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Nemours, Alfred I. duPont Hospital for Children, Jefferson Medical College, Wilmington, DE, USA. amythomp@nemours.org
authors.forename: Amy D
authors.initials: AD
authors.lastname: Thompson
authors.forename: Keri A
authors.initials: KA
authors.lastname: Cohn
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.forename: Todd
authors.initials: T
authors.lastname: Lyons
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Welsh
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Hines
authors.forename: Lise E
authors.initials: LE
authors.lastname: Nigrovic
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D055499:Catheter-Related Infections / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008193:Lyme Disease / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D000900:Anti-Bacterial Agents