title: Incidence and Patterns of Extended-Course Antibiotic Therapy in Patients Evaluated for Lyme Disease.
abstract: BACKGROUND
  Most patients with Lyme disease (LD) can be treated effectively with 2-4 weeks of antibiotics. The Infectious Disease Society of America guidelines do not currently recommend extended treatment even in patients with persistent symptoms.
  
  
  METHODS
  To estimate the incidence of extended use of antibiotics in patients evaluated for LD, we retrospectively analyzed claims from a nationwide US health insurance plan in 14 high-prevalence states over 2 periods: 2004-2006 and 2010-2012.
  
  
  RESULTS
  As measured by payer claims, the incidence of extended antibiotic therapy among patients evaluated for LD was higher in 2010-2012 (14.72 per 100 000 person-years; n = 684) than in 2004-2006 (9.94 per 100 000 person-years; n = 394) (P < .001). Among these patients, 48.8% were treated with ≥2 antibiotics in 2010-2012 and 29.9% in 2004-2006 (P < .001). In each study period, a distinct small group of providers (roughly 3%-4%) made the diagnosis in >20% of the patients who were evaluated for LD and prescribed extended antibiotic treatment.
  
  
  CONCLUSIONS
  Insurance claims data suggest that the use of extended courses of antibiotics and multiple antibiotics in the treatment of LD has increased in recent years.
authors.affiliation: Computational Health Informatics Program, Boston Children's Hospital.
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Tseng
authors.affiliation: Computational Health Informatics Program, Boston Children's Hospital Department of Pediatrics.
authors.forename: Aurel
authors.initials: A
authors.lastname: Cami
authors.affiliation: Department of Institute for Healthcare Improvement, Cambridge Division of Infectious Diseases, Boston Children's Hospital.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Goldmann
authors.affiliation: Bureau of Infectious Disease, Massachusetts Department of Public Health, Jamaica Plain.
authors.forename: Alfred
authors.initials: A
authors.lastname: DeMaria
authors.affiliation: Computational Health Informatics Program, Boston Children's Hospital Department of Pediatrics Department of Biomedical Informatics, Harvard Medical School, Boston.
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Mandl
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008193:Lyme Disease / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: antibiotic use; inappropriate prescribing; insurance claim review; lyme disease