Presentation: Inappropriate Antibiotic Treatment in “Chronic Lyme Disease” (2007)

1519 Inappropriate Antibiotic Treatment in “Chronic Lyme Disease”

PURPOSE: Many patients without explicit historical, objective clinical or serological (positive ELISA with confirmatory immunoblot) evidence of Lyme disease (LD) are diagnosed with “Chronic LD” and receive multiple courses of antibiotics for their non-specific complaints. A number of these patients present with depression and/or report high levels of psychological stress which might better account for their symptoms. One purpose of the larger Living with Lyme Disease (LLD) study was to assess medical treatment of LD patients including those who have never met criteria for LD.
METHODS: Every patient between the ages of 18 and 70 presenting to the LD clinic of a large university medical school was invited to participate in the LLD study assessing the role of psychological factors in patients ascribing symptoms to LD. Patients were assessed for psychiatric comorbidity (e.g., depression, anxiety, personality disorders) and other psychological variables before participating in a physician assessment. This assessment included patient interview, chart review and a physical examination.
RESULTS: Of 240 patients, 169 (70.4%) at no time met CDC serological or clinical criteria for LD (NoLD). Nonetheless, 114 (67.5%) of the NoLD patients received at least one course of oral, IV or IM antibiotic therapy. 106 (62.7%) NoLD patients received at least one course of oral antibiotic treatment and 47 (27.8%) received 2 or more courses, while 33 (19.5%) received at least one course of IV or IM antibiotic treatment and 11 (6.5%) received multiple courses of IV or IM antibiotic treatment. All patients reported pain and most reported fatigue (83.4%), sleep disturbance (65.1%), and/or neurocognitive impairment (62.7%). We found that 55 (32.5%) NoLD patients met criteria for another readily identifiable medical condition, e.g. osteoarthritis, and another 75 (44.4%) were diagnosed with fibromyalgia (FM) or a FM-like disorder. Psychiatric comorbidity was present in 58.0% of all NoLD patients, while 68.4% of NoLD patients with FM or medically unexplained symptoms demonstrated psychiatric comorbidity.
CONCLUSIONS: The symptoms of over 70% of “chronic LD” patients assessed in this study were not attributable to current or previous B.burgdorferi infection and yet oral and/or IV or IM antibiotics were received by almost 68% with 30.2% receiving multiple courses. The focus on LD and unnecessary antibiotic treatment pose the three-fold risks of inattention to psychological factors, exacerbation of stress related to an incorrect and apparently refractory illness, and toxicity related to drug and prolonged IV access. An integrative treatment strategy for these patients is warranted, as is a better appreciation of the societal and personal costs of incorrectly diagnosing LD in patients with no objective evidence of B. burgdorferi infection.

  A.L. Hassett, NIH K08 MH065360-05, 2; D.C. Radvanski, None; S.V. Savage, None; L.N. Moorthy, None; L.H. Sigal, Bristol-Myers Squibb, 3.