Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale, Arizona.
Clin Infect Dis. 2018 Oct 30;67(10):1568-1574. doi: 10.1093/cid/ciy329.
Non-guideline-endorsed posttreatment courses of antibiotics for post-Lyme disease syndrome (PLDS) have been linked to adverse patient outcomes, but these findings have yet to be validated in large systematic evaluations.
A retrospective cohort analysis of medical and pharmacy claims derived from the Truven Health Market Scan Commercial Claims and Encounters Database assessed 90-day incidence rates of adverse events (AEs) associated with PLDS treatment (PLDS-Tx). Patients were diagnosed with PLDS ≥6 months after initial diagnosis and standard antibiotic treatment for Lyme disease. Comparison cohorts included intravenous (IV) PLDS-Tx with or without oral antibiotics; oral antibiotic-only PLDS-Tx; or neither.
Composite AE incidence rates were higher for patients treated with IV or oral PLDS-Tx than for patients not receiving either treatment (18.7%, 16.8%, and 13.4%, respectively; P = .019). Significant between-group differences in AE incidence rates were noted for electrolyte imbalance (4.0%, 1.5%, and 0.7%, respectively; P = .001) and infection (14.0%, 12.7%, and 9.3%; P = .006). Infection prevalence increased by 22.0% in the IV treatment group and 17.7% in the oral group. Incidence rates for all-cause and AE-related hospital stays and emergency department visits were higher for treated than nontreated patients, particularly when treatment was IV (all P < .01). Of IV-treated patients, 7.3% experienced an incident all-cause inpatient stay and 11.3% an incident all-cause emergency department visit, compared with, respectively, 2.2% and 3.4% of those treated with oral antibiotics and 0.9% and 1.9% of nontreated patients.
Use of IV therapies or oral antibiotics for PLDS was associated with increased patient morbidity within 90 days.
非指南推荐的治疗莱姆病后综合征（PLDS）的后续疗程抗生素与不良患者结局相关，但这些发现尚未在大型系统评估中得到验证。
从 Truven Health Market Scan 商业索赔和就诊数据库中提取的医疗和药房索赔的回顾性队列分析评估了与 PLDS 治疗（PLDS-Tx）相关的不良事件（AE）的 90 天发生率。患者在初始莱姆病诊断和标准抗生素治疗后≥6 个月被诊断为 PLDS。对照队列包括静脉（IV）PLDS-Tx 联合或不联合口服抗生素；仅口服抗生素 PLDS-Tx；或两者均无。
接受 IV 或口服 PLDS-Tx 治疗的患者的复合 AE 发生率高于未接受任何治疗的患者（分别为 18.7%、16.8%和 13.4%；P =.019）。AE 发生率的显著组间差异在电解质失衡（分别为 4.0%、1.5%和 0.7%；P =.001）和感染（14.0%、12.7%和 9.3%；P =.006）方面观察到。IV 治疗组感染率增加 22.0%，口服组增加 17.7%。与未治疗患者相比，接受治疗的患者全因和 AE 相关住院和急诊就诊的发生率更高，尤其是接受 IV 治疗的患者（所有 P<.01）。在接受 IV 治疗的患者中，7.3%经历了全因住院事件，11.3%经历了全因急诊就诊事件，而接受口服抗生素治疗的患者分别为 2.2%和 3.4%，未接受治疗的患者分别为 0.9%和 1.9%。
PLDS 使用 IV 治疗或口服抗生素与 90 天内患者发病率增加相关。
