Impact of long-term antibiotic therapy on symptoms evocative of chronic lyme disease

Abstract number: 1134_01_108

Clarissou J., Salomon J., Guillemot D., Bernede C., Ader F., Bernard L., Perronne C.M.

Objectives:  

chronic lyme disease (CLD) could be partly due to the persistence of Borrelia. The aim of our study is to determine the effect of long term antibiotic therapy on heterogeneous symptoms evocative of CLD.

Methods:  

100 patients (pts) (65% female, mean age 45 y) with a diagnosis of CLD were included in an open study. A clinical score was designed based on the following items: erythema migrans (56% of cases), positive serology for Borrelia (51%), tick bite (69%), combination of categories of signs or symptoms: systemic (88%), neurologic (94%), articular (91%), cutaneous (76%), psychiatric (77%), cardiorespiratory (73%) or muscular (67%). Diagnosis was classified as very probable (67%), probable (25%) or uncertain (8%), according to the clinical score. An antibiotic therapy was given for 3 to 6 months (penicillin G, ceftriaxone, amoxicillin, doxycycline or clarithromycin). The number (No) of subjective symptoms (SS) and objective signs (OS) was measured at day 0 (D0), month 3 (M3) and M6.

Results:  

The No of pts with 4 or more categories of signs or symptoms was 82% at D0, 34% at M3 and 31% at M6. The mean No of SS was 12 at D0, 6 at M3 and 5 at M6. The mean No of OS was 2.7 at D0, 1.4 at M3 and 1 at M6. The differences were significant for very probable or probable cases (p < 0.001).

Conclusion:  

This study shows an important improvement of the clinical conditions of pts with CLD treated with a prolonged course of antibiotic. A controlled randomized trial with a strict case definition and a follow up longer than 3 months is needed.