ANTIBIOTIC-THERAPY FOR LYME-DISEASE IN MARYLAND

The recommended treatment of Lyme disease is evolving and important qu estions remain unanswered, such as (a) Are inexpensive oral regimens e ffective in curing acute illness and preventing arthritic, neurologic, and cardiac manifestations or are much more costly, and potentially t oxic, intravenous antibiotics required? (b) Are relatively short 2- to 3-week courses of antibiotics sufficient or are prolonged regimens of a month, or more, better? This study reviews antibiotic therapy presc ribed by Maryland physicians for the 283 cases reported in 1991 that m eet the Centers for Disease Control and Prevention's case definition f or Lyme disease. The purpose of the review was to obtain baseline info rmation on the antibiotics being used by physicians in practice to tre at patients that they believe have Lyme disease. The most frequently p rescribed antibiotics for either the 60 percent of patients presenting with erythema migrans or the 40 percent with arthritic, neurologic, o r cardiac manifestations were oral doxycycline (47 percent), tetracycl ine (11 percent), and amoxicillin (13 percent). Seventy-one percent of therapeutic courses were for 2 to 3 weeks. Amoxicillin was used in tw o-thirds of children younger than 8 years. Sixty (21 percent) received intravenous therapy, of which ceftriaxone, with or without other anti biotics, was almost always (95 percent) used. Intravenous therapy was more frequently given to those with arthritic, neurologic, and cardiac manifestations than to those with erythema migrans (odds ratio = 3.7) and to those with these systemic symptoms along with erythema migrans than to those with erythema migrans alone (odds ratio = 3.8). The ave rage course was 2 days longer in treating those with arthritic, neurol ogic, or cardiac manifestations than in treating those with erythema m igrans alone (P = 0.05). An epidemiologic assessment of antibiotics pr escribed by the physicians in Maryland to treat Lyme disease in 1991 s hows the choices, dosage, and duration of drugs generally followed tho se most frequently recommended in the literature. Also, it shows that efforts to educate physicians should be directed more towards the diag nosis rather than the treatment of Lyme disease.