Project Details

Complications of Extended Antibiotic Therapy and the Misdiagnosis of Chronic Lyme Disease

Sabrina Gmuca, MD

Summary

BACKGROUND: Children and young adults labeled with post treatment Lyme disease syndrome (PTLDS) are at serious risk of extended antibiotic therapy as well as a misdiagnosis of PTLDS rather than other chronic pain syndromes such as juvenile fibromyalgia syndrome. Little is known regarding the exposure of children and young adults with PTLDS to extended antibiotic therapy nor the prevalence of serious complications among this patient population. GAP: While extended antibiotic treatment for the diagnosis of PTLDS is common, the prevalence of and risk factors for serious complications from this therapy are unknown, as is the prevalence of children and young adults diagnosed as having PTLDS. HYPOTHESIS: We hypothesize that children and young adults with PTLDS administered extended antibiotic therapy have a greater odds of a serious complication than children administered standard antibiotic therapy. We also hypothesize that these patients are at greater risk of receiving an alternative medical diagnosis. METHODS: This was a retrospective cohort study, using national healthcare claims data, of subjects ≥3 and ≤21 years old with PTLDS from 2000 – 2016 and the primary exposure was antibiotic therapy for PTLDS (PTLDS-Tx). The primary outcome was presence of a serious complication (including bacterial infections, hospitalizations or deep venous thromboses) for which we estimated odds ratios in order to identify associated risk factors. RESULTS: A total of 186 children and young adults were diagnosed with PTLDS, the majority of whom were female (60%) and Caucasian (88%). Nearly 40% of the cohort was treated with extended antibiotic therapy, most commonly azithromycin (39%), doxycycline (24%), and amoxicillin (20%). Any serious complication, including sepsis, C. difficile infection, or hospitalization, occurred in more than 1/3 of patients, regardless of antibiotic exposure (OR: 0.84 [95% CI: 0.44 - 1.59; p=0.59]). Co-morbid fibromyalgia syndrome (33%), depression (18%), anxiety (29%) and chronic fatigue syndrome (12%) were relatively common but were not more common among the PTLDS-Tx group. IMPACT: Despite recommendations against the use of extended antibiotic therapy for the treatment of PTLDS, a significant proportion of children and young adults were nonetheless prescribed antibiotic therapy for PTLDS. Reassuringly antibiotic exposure was not associated with the presence of serious complications but further understanding of providers’ persistent prescribing patterns for antibiotics for pediatric PTLDS is warranted. Website Link: https://cpce.research.chop.edu/about-us/team-members/sabrina-gmuca-md-msce https://policylab.chop.edu/people/sabrina-gmuca