Benefit of intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease
Benefit of intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease
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DOI：
10.2147/ijgm.s23829
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发表时间：
2011-01-01
影响因子：
2.3
通讯作者：
Johnson, Lorraine
中科院分区：
文献类型：
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作者：
Stricker, Raphael B.;DeLong, Allison K.;Johnson, Lorraine
背景资料：我们以前已经证明，延长静脉抗生素治疗与神经系统莱姆病患者的低发病率和无死亡率相关。在这项研究中，我们评估了延长静脉内抗生素治疗的好处与神经系统莱姆病diseases.Methods的症状：患者有显着的神经系统症状和阳性检测伯氏疏螺旋体治疗静脉内抗生素，和每两周一次的症状严重程度进行评估，使用六个级别的顺序量表。在研究中，先验地选择了四种症状作为主要结局指标，即疲劳、认知、肌痛和关节痛。根据治疗时间将患者分为五组使用混合效应比例优势模型分析治疗后1-4、5-8、9-12、13-24和25-52周的主要症状变化以及主要症状变化与治疗时间的关系。在158例随访超过1年的患者中，平均每人有6.7次随访（中位数5，范围2-24）。最后一次随访日平均为入组后96天（中位数69，范围7-354天），与抗生素治疗的持续时间相对应。在研究期间的一个或多个时间点，每种主要症状均得到显著改善。对于认知、疲劳和肌痛，疗程最长（25-52周）的患者改善最大，改善的比值比（OR）分别为1.97（P = 0.02）、2.22（P < 0.01）和2.08（P = 0.01）。与此相反，关节痛只有显着改善在最初的1-4周的治疗（OR：1.57，P = 0.04），和更长的治疗的有益效果没有达到统计学意义的symptoms.Conclusion：延长静脉抗生素治疗与改善认知，疲劳和肌痛的患者提到治疗神经系统莱姆病。治疗25-52周可能是必要的，以获得这些患者的症状改善。
Background: We have shown previously that extended intravenous antibiotic therapy is associated with low morbidity and no mortality in patients referred for treatment of neurologic Lyme disease. In this study, we evaluated the benefit of extended intravenous antibiotic therapy in patients with symptoms of neurologic Lyme disease.Methods: Patients with significant neurologic symptoms and positive testing for Borrelia burgdorferi were treated with intravenous antibiotics, and biweekly evaluation of symptom severity was performed using a six-level ordinal scale. Four symptoms were selected a priori as primary outcome measures in the study, ie, fatigue, cognition, myalgias, and arthralgias. Patients were placed into five groups according to time on treatment (1-4, 5-8, 9-12, 13-24, and 25-52 weeks), and changes in the primary symptoms as a function of time on treatment were analyzed using a mixed-effects proportional odds model.Results: Among 158 patients with more than one follow-up visit who were monitored for up to 1 year, there were on average 6.7 visits per person (median 5, range 2-24). The last follow-up day was on average 96 days after enrollment (median 69, range 7-354 days), corresponding to the length of antibiotic therapy. Each primary symptom was significantly improved at one or more time points during the study. For cognition, fatigue, and myalgias, the greatest improvement occurred in patients on the longest courses of treatment (25-52 weeks) with odds ratios (OR) for improvement of 1.97 (P = 0.02), 2.22 (P < 0.01), and 2.08 (P = 0.01), respectively. In contrast, arthralgias were only significantly improved during the initial 1-4 weeks of therapy (OR: 1.57, P = 0.04), and the beneficial effect of longer treatment did not reach statistical significance for this symptom.Conclusion: Prolonged intravenous antibiotic therapy is associated with improved cognition, fatigue, and myalgias in patients referred for treatment of neurologic Lyme disease. Treatment for 25-52 weeks may be necessary to obtain symptomatic improvement in these patients.