Computational Health Informatics Program, Boston Children's Hospital.
Computational Health Informatics Program, Boston Children's Hospital Department of Pediatrics.
Clin Infect Dis. 2015 Nov 15;61(10):1536-42. doi: 10.1093/cid/civ636. Epub 2015 Jul 29.
Most patients with Lyme disease (LD) can be treated effectively with 2-4 weeks of antibiotics. The Infectious Disease Society of America guidelines do not currently recommend extended treatment even in patients with persistent symptoms.
To estimate the incidence of extended use of antibiotics in patients evaluated for LD, we retrospectively analyzed claims from a nationwide US health insurance plan in 14 high-prevalence states over 2 periods: 2004-2006 and 2010-2012.
As measured by payer claims, the incidence of extended antibiotic therapy among patients evaluated for LD was higher in 2010-2012 (14.72 per 100 000 person-years; n = 684) than in 2004-2006 (9.94 per 100 000 person-years; n = 394) (P < .001). Among these patients, 48.8% were treated with ≥2 antibiotics in 2010-2012 and 29.9% in 2004-2006 (P < .001). In each study period, a distinct small group of providers (roughly 3%-4%) made the diagnosis in >20% of the patients who were evaluated for LD and prescribed extended antibiotic treatment.
Insurance claims data suggest that the use of extended courses of antibiotics and multiple antibiotics in the treatment of LD has increased in recent years.
大多数莱姆病（LD）患者可以通过 2-4 周的抗生素治疗有效治疗。美国传染病学会指南目前不建议即使在持续性症状患者中延长治疗。
为了估计在评估 LD 的患者中抗生素延长使用的发生率，我们回顾性分析了来自全国范围内 14 个高患病率州的一项美国健康保险计划在两个时期（2004-2006 年和 2010-2012 年）的索赔数据。
按支付者索赔计算，2010-2012 年评估 LD 的患者中抗生素延长治疗的发生率高于 2004-2006 年（每 100000 人年 14.72 例；n = 684）（P <.001）。在这些患者中，48.8%在 2010-2012 年接受了≥2 种抗生素治疗，29.9%在 2004-2006 年接受了治疗（P <.001）。在每个研究期间，一小部分（约 3%-4%）提供者在评估 LD 并开具抗生素延长治疗的患者中诊断出超过 20%的患者。
保险索赔数据表明，近年来 LD 治疗中延长疗程和使用多种抗生素的情况有所增加。
