42. The Treatment of North American Lyme Neuroborreliosis with Oral Antibiotics and IV Ceftriaxone: a comparative case series
Session: Posters in the Park: Posters in the Park
Wednesday, October 3, 2018: 5:30 PM
Room: N Hall D Opening Reception and Posters in the Park Area
Posters
  • Posters in the Park - Patel, A.pdf (785.0 kB)
  • Background: Standard of care for early Lyme Neuroborreliosis (LNB), which is defined as manifestations of radiculopathy, cranial neuropathy, or meningitis, based off of IDSA guidelines, is IV ceftriaxone. Multiple European trials have demonstrated equal efficacy of oral antibiotics to IV antibiotics for the treatment of LNB. Oral antibiotics have been shown to have several advantages such as fewer complications, greater ease of use, and lower cost. To date, there has been no randomized controlled trials in the United States to answer this important question. This paper is a retrospective comparative case series in patients with early LNB treated with oral antibiotics compared to those treated with IV ceftriaxone.

    Methods: This retrospective analysis evaluated adult patients between the years of 2013 to 2017. Inclusion criteria were neurological symptoms of early LNB presenting with either cranial neuropathy, radiculopathy, or meningitis along with a positive two-tier test, a CSF white blood cell count of more than five per mL, or an MRI showing cranial nerve enhancement. Patients were treated with either IV ceftriaxone or oral antibiotics (doxycycline or minocycline) daily for a minimum of 14 days. Primary outcome was improvement of neurological exam, MRI findings, or CSF analysis within 8 weeks post treatment.

    Results: 22 patients were found to meet criteria, 17 patients were used. The most common presenting symptom was cranial nerve 7 palsy. Mean symptom duration was 37 days in oral antibiotic therapy group vs 17 days in the IV therapy group. All but 2 patients had a lymphocytic meningitis at presentation, however patients receiving oral antibiotic therapy had a mean cell count of 233 cells/ml compared to IV group of 108 cells/ml. All but one patient in this study had improvement in neurologic examination, radiographic abnormalities, or cerebrospinal fluid leukocytosis despite treatment group.

    Conclusion: This comparative case series supports the results of the randomized controlled European trials demonstrating that oral antibiotic therapy is as effective as IV therapy in the treatment of early LNB. Although our study numbers did not allow for statistical significance, this important data will be used as a justification for a prospective randomized multi-center controlled trial.

    Ashka Patel, DO, Internal Medicine, Geisinger Medical Center, Danville, PA and Kelly Baldwin, MD, Geisinger Medical Center, Danville, PA

    Disclosures:

    A. Patel, None

    K. Baldwin, None

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