Lyme
Study in Annals of Internal Medicine Flawed
ILADS RESPONSE
TO ARTICLE
Dr. Andrea Gaito, M.D.,
F.A.C.R.
Immediate Past President, International Lyme and Associated
Diseases Society
May, 2003
The article entitled
“Duration of Antibiotic Therapy for Early Lyme Disease“ recently published in the Annals of Internal Medicine is flawed in its methodology and in its findings. The collective experience of ILADS physicians has shown that 10 days of therapy has consistently proven insufficient in preventing the development of systemic manifestations of Lyme disease. Our experience proves most patients who are treated with short duration antibiotics return for repeat therapy when their symptoms do not improve.
The study failed on many levels. As the report points out, it excluded “all patients with underlying conditions that might interfere with the evaluation on follow up.” Additionally, many of the outcome measures were rendered, based on the clinical observation of objective criteria, which is not always present in Lyme disease patients.
The article also failed to disclose the nature of the “unrelated illnesses”
that more than half of these patients suffered. These patients were then treated with a second course of antibiotics. This insufficient information leaves many important questions unanswered. Furthermore, the study fails to mention which antibiotics were used and whether they had any activity towards Lyme disease. And, finally, more than half of the patients in this study were retreated over the ensuring 30 months under the guise of other diseases.
The only conclusion this study demonstrated is that, indeed, short duration antibiotic therapy warrants retreatment.
The better
title for this inadequate and misleading study would be:
“Short-term
therapy for Early Lyme Disease yields treatment failure in 50% of patients.”
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