Incidence and Patterns of Extended-Course Antibiotic Therapy in Patients Evaluated for Lyme Disease
Incidence and Patterns of Extended-Course Antibiotic Therapy in Patients Evaluated for Lyme Disease
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DOI：
10.1093/cid/civ636
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发表时间：
2015-11-15
影响因子：
11.8
通讯作者：
Mandl, Kenneth D.
中科院分区：
文献类型：
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作者：
Tseng, Yi-Ju;Cami, Aurel;Mandl, Kenneth D.
背景。大多数莱姆病 (LD) 患者可以通过 2-4 周的抗生素有效治疗。美国传染病学会指南目前不建议延长治疗，即使是症状持续的患者也是如此。方法。为了估计接受 LD 评估的患者中长期使用抗生素的发生率，我们回顾性分析了 2004 年、2006 年和 2010-2012 年 2 个时期内 14 个高患病率州的美国全国健康保险计划的索赔情况。结果。根据付款人索赔情况进行衡量，2010-2012 年接受 LD 评估的患者中延长抗生素治疗的发生率（每 10 万人年 14.72 例；n = 684）高于 2004-2006 年（每 10 万人年 9.94 例；n = 394）（P < .001）。在这些患者中，48.8% 在 2010-2012 年接受过 2 种以上抗生素治疗，29.9% 在 2004-2006 年接受治疗 (P < .001)。在每个研究期间，一小群不同的提供者（大约 3%-4%）对超过 20% 的患者做出了诊断结论。保险索赔数据表明，近年来，延长抗生素疗程和多种抗生素治疗 LD 的情况有所增加。
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: 20042006 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 patientConclusions. 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.