| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
From the Departments of Neurology (Drs. Krupp and Coyle, and P. Melville), Preventive Medicine (Drs. Hyman, Grimson, and Ahnn, and B. Chandler), and Medicine (Drs. Dattwyler), Stony Brook University Medical Center, Stony Brook, NY.
Address correspondence and reprint requests to Dr. L.B. Krupp, Department of Neurology, University Medical Center at Stony Brook, Stony Brook, NY 11794-8121; e-mail: lkrupp{at}notes.cc.sunysb.edu
Objective: To determine whether post Lyme syndrome (PLS) is antibiotic responsive.
Methods: The authors conducted a single-center randomized double-masked placebo-controlled trial on 55 patients with Lyme disease with persistent severe fatigue at least 6 or more months after antibiotic therapy. Patients were randomly assigned to receive 28 days of IV ceftriaxone or placebo. The primary clinical outcomes were improvement in fatigue, defined by a change of 0.7 points or more on an 11-item fatigue questionnaire, and improvement in cognitive function (mental speed), defined by a change of 25% or more on a test of reaction time. The primary laboratory outcome was an experimental measure of CSF infection, outer surface protein A (OspA). Outcome data were collected at the 6-month visit.
Results: Patients assigned to ceftriaxone showed improvement in disabling fatigue compared to the placebo group (rate ratio, 3.5; 95% CI, 1.50 to 8.03; p = 0.001). No beneficial treatment effect was observed for cognitive function or the laboratory measure of persistent infection. Four patients, three of whom were on placebo, had adverse events associated with treatment, which required hospitalization.
Conclusions: Ceftriaxone therapy in patients with PLS with severe fatigue was associated with an improvement in fatigue but not with cognitive function or an experimental laboratory measure of infection in this study. Because fatigue (a nonspecific symptom) was the only outcome that improved and because treatment was associated with adverse events, this study does not support the use of additional antibiotic therapy with parenteral ceftriaxone in post-treatment, persistently fatigued patients with PLS.
This article has been cited by other articles:
|
|
 |
|
  B. A. Fallon, J. G. Keilp, K. M. Corbera, E. Petkova, C. B. Britton, E. Dwyer, I. Slavov, J. Cheng, J. Dobkin, D. R. Nelson, et al. A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy Neurology, March 25, 2008; 70(13): 992 - 1003. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Halperin Prolonged Lyme disease treatment: Enough is enough Neurology, March 25, 2008; 70(13): 986 - 987. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Mayer, S. Merz, E. L. Maloney, K. D. Holmes, D. J. Volkman, D. J. Cameron, M. S. Drapkin, H. M. Feder Jr., and the Ad Hoc International Lyme Disease Group An Appraisal of "Chronic Lyme Disease" N. Engl. J. Med., January 24, 2008; 358(4): 428 - 431. [Full Text] [PDF]
|
|
|
|
|
|
H. M. Feder Jr., B. J.B. Johnson, S. O'Connell, E. D. Shapiro, A. C. Steere, G. P. Wormser, and the Ad Hoc International Lyme Disease Group A Critical Appraisal of "Chronic Lyme Disease" N. Engl. J. Med., October 4, 2007; 357(14): 1422 - 1430. [Full Text] [PDF]
|
|
|
|
|
|
J. J. Halperin, E. D. Shapiro, E. Logigian, A. L. Belman, L. Dotevall, G. P. Wormser, L. Krupp, G. Gronseth, and C. T. Bever Jr Practice Parameter: Treatment of nervous system Lyme disease (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology Neurology, July 3, 2007; 69(1): 91 - 102. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. E. Gladstone, K. W. Zamkoff, L. Krupp, R. Peyster, P. Sibony, C. Christodoulou, E. Locher, and P. K. Coyle High-Dose Cyclophosphamide for Moderate to Severe Refractory Multiple Sclerosis Arch Neurol, October 1, 2006; 63(10): 1388 - 1393. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Cairns Author's response to comments by Sigal and Hassett, Phillips et al., and Shapiro et al. Int. J. Epidemiol., December 1, 2005; 34(6): 1440 - 1443. [Full Text] [PDF]
|
|
|
|
|
|
V. Cairns and J. Godwin Post-Lyme borreliosis syndrome: a meta-analysis of reported symptoms Int. J. Epidemiol., December 1, 2005; 34(6): 1340 - 1345. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. D Shapiro, R. Dattwyler, R. B Nadelman, and G. P Wormser Response to meta-analysis of Lyme borreliosis symptoms Int. J. Epidemiol., December 1, 2005; 34(6): 1437 - 1439. [Full Text] [PDF]
|
|
|
|
|
|
February 22 Highlight and Commentary: Borrelia burgdorferi, the brain and biologic plausibility Neurology, February 22, 2005; 64(4): 585 - 585. [Full Text] [PDF]
|
|
|
|
 |
|
 N. S. Zeidner, K. S. Brandt, E. Dadey, M. C. Dolan, C. Happ, and J. Piesman Sustained-Release Formulation of Doxycycline Hyclate for Prophylaxis of Tick Bite Infection in a Murine Model of Lyme Borreliosis Antimicrob. Agents Chemother., July 1, 2004; 48(7): 2697 - 2699. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 More Studies on Prolonged Antibiotic Therapy for Chronic Lyme Disease Journal Watch Dermatology, August 27, 2003; 2003(827): 11 - 11. [Full Text]
|
|
|
|
 |
|
 More Studies on Prolonged Antibiotic Therapy for Chronic Lyme Disease Journal Watch (General), July 15, 2003; 2003(715): 4 - 4. [Full Text]
|
|
|
|
|
|
I. Steiner Treating post Lyme disease: Trying to solve one equation with too many unknowns Neurology, June 24, 2003; 60(12): 1888 - 1889. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
