Management of suspected Lyme borreliosis: experience from an outpatient parenteral antibiotic therapy service.
OBJECTIVE
Lyme borreliosis (LB) is the most common human tick-borne infection in Europe and the USA. In this study we set out to analyse the outcome of patients treated for Lyme disease via outpatient parenteral antibiotic therapy (OPAT) and the appropriateness of this treatment using current guidelines.


METHODS
This was a retrospective review of all patients with suspected LB managed via OPAT in Glasgow in 2000-11.


RESULTS
Of 72 patients treated for suspected LB, 35 patients (49%) were treated in accordance with guidelines and 36 (50%) were treated with no specific guidelines. A definite improvement was seen in 20 patients (28%). Adverse reactions were documented in 29 (40%) patients with neutropenia, and mild liver function derangement was most commonly observed.


CONCLUSIONS
These results show the complexity of translating well-substantiated regimens from clinical trials to actual clinical practice. OPAT was an effective way of administering parenteral therapy for Lyme disease but should not be undertaken lightly due to the rate of adverse events and low rates of success in certain patient groups seen in this study. In view of this, stricter criteria for inclusion to OPAT in line with published guidance should be applied to minimize patient harm and optimize success.
c/o Brownlee Centre for Infectious Diseases, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 8TA, UK. bwhite@nhs.net
B
B
White
R A
RA
Seaton
T J
TJ
Evans
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D005260:Female; D018718:Home Infusion Therapy / Q000191:economics / Q000379:methods*; D006801:Humans; D007262:Infusions, Intravenous; D008193:Lyme Disease / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents