Complications of Extended Antibiotic Therapy and the Misdiagnosis of Chronic Lyme Disease
Sabrina Gmuca, MD
BACKGROUND: Children labeled with chronic Lyme disease are at serious risks of extended antibiotic therapy as well as a misdiagnosis of chronic Lyme disease rather than other chronic pain syndromes such as juvenile fibromyalgia syndrome. Little is known regarding the prevalence of juvenile fibromyalgia syndrome among children with chronic Lyme disease nor the prevalence of serious complications from extended antibiotic therapy for chronic Lyme disease.
GAP: While extended antibiotic treatment for the diagnosis of chronic Lyme disease is common, the prevalence of and risk factors for serious complications from this therapy are unknown, as is the prevalence of children misdiagnosed as chronic Lyme disease.
HYPOTHESIS: We hypothesize that children with chronic Lyme disease administered extended antibiotic therapy have a greater odds of a serious complication than children administered standard antibiotic therapy. We also hypothesize that these children are at greater risk of receiving an alternative medical diagnosis.
METHODS: This is a retrospective cohort study, using national healthcare claims data, of subjects <21 years old with chronic Lyme disease from 2000 – 2016 and the primary exposure will be extended antibiotic therapy. The primary outcome will be presence of a serious complication (including bacterial infections, hospitalizations or deep venous thromboses) for which we will estimate the odds ratio and identify associated risk factors.
IMPACT: Demonstration and quantification of the risk of complications from extended antibiotic therapy in patients labeled with chronic Lyme disease will help inform national policy changes to promote appropriate antibiotic use for this condition and inform the design of future educational interventions.